
Qass 3\C>6\ 



THE 



H uman M achine 



ITS 



CARE and REPAIR 



OR HOW TO 

DEVELOP THE BODY, PRESERVE THE HEALTH, MEET 

EMERGENCIES, NURSE THE SICK 

AND TREAT DISEASE 



- BY TWELVE AUTHORS 
Edited by W. E. McVEY, B.S., M.D. 



JHmUU©TM®TlEJn) 



Topeka, Kansas 
HERBERT S. REED 

*%9 



EIVED. 



Library of Congret* 
Office of t 

fleglster of Copyrights 



\ 



c 



49864 

Entered According to the Act of Congress in the Year 1899, 

By HERBERT S. REED, 

In the Office of the Librarian of Congress at Washington. 

ALL RIGHTS RESERVED. 



TO BE SOLD BY SUBSCRIPTION. 



SECOND COPY, 






Introduction. 



NATURE produces diseases and their antidotes. The pharmacist 
prepares and compounds, but the physician alone interprets 
symptoms, seeks out their causes and devises the cure. Un- 
less sure of his remedy, it is as criminal to give it to a beggar as to 
a prince. 

Man is the epitome of nature, and has all its elements within 
him. Its forces are constantly acting upon him, but he may react 
and make them subservient to his will. Observing the relations of 
cause and effect, he is king; but, failing in this, they become his 
master, inflicting as penalties all manner of diseases — become a 
monster that accepts no excuses and knows no mercy, but for broken 
law wreaks vengeance on the innocent and the vicious alike, making 
them victims of infinite ills and of the hordes of parasitic life. 

That wisdom is better than rubies has gone unchallenged for 
thirty centuries, until to-day the proverb is doubly true, for the 
wisdom of the present includes more perfect knowledge of the causes 
and control of diseases than was attained in any age of all the past. 
As a correct use of the facts now known to science would prevent 
most cases of sickness, and annually save millions of lives, how 
important that the masses be taught until everywhere the incanta- 
tions of the voodoo shall give way to germicides, the darkness of 
superstition to the light of biology flooding the world. 

To remain in the front rank of the world's benefactors, the physi- 
cian, too, must add to the sum of useful knowledge in terms that can 
be understood. "All that a man hath will he give for his life," and 
he should no longer be barred from knowing himself, from acquir- 
ing the best possible knowledge of physiology and hygiene, and from 
learning to outwit and destroy the micro-organisms that would make 
him their prey. 

To meet these demands is only a part of the purposes of this 
book, for it has also become imperative that the profession and the 
laity should better understand each other. The doctor has stood 
aloof from the people too long, to their anxious inquiries has replied 
in an unknown tongue, and mystified what should have been made 
plain, until it is not wholly his own fault that the average individual 

3 



4 INTRODUCTION. 

knows less of himself than of almost everything else. You may 

doubt this statement, or say that it is not true, but the trainloads of 
patent dopes, the worse than worthless nostrums marketed annually, 
and the golden harvests gathered all the year by advertising char- 
latans, prove that it is true; and that many of our commonwealths, 
though providing liberally for the quarantine of cattle and hogs, 
proverbially fail to appropriate or legislate for the adequate protec- 
tion of human life, emphasizes the density of the ignorance pre- 
vailing, even among the generally well informed, as to the causes 
of disease and premature death. 

Education is the only remedy. Encourage study. Disseminate 
knowledge. Let all be informed upon sanitation and the nature of 
the more common maladies, and there will come ability to discern 
between quackery and skill, between the false and the true. And 
the physician's usefulness will keep pace, always, with the advance. 
Indeed, it is only where there is this intelligence that he can have the 
unswerving confidence of the patient and his friends, that cooperation 
in emergencies, so essential to the highest success in long and 
desperate combats with disease. 

Parents!. We also have a message for you. No longer assume 
that there is any virtue in ignorance. In a proper way teach the boys 
and girls, while they are yet innocent and pure, the purposes of each 
organ, the meaning of awakening instincts, the mysteries of pro- 
creation, and the fearful retributions following misuse of the 
sexual powers, instead of leaving them to acquire fragmentary or 
vicious ideas from impure companions, and, perhaps, to become 
helpless victims of the vile. 

The several departments have been prepared by separate authors 
who are well known to have had special experience in their chosen 
fields. To these physicians our best thanks are due for their generous 
and able assistance. 

A strictly scientific classification has not been attempted. As far 
as possible, plain, simple language has been used, and technical terms 
avoided. It is not expected that anyone, not possessed of special 
knowledge and experience, will attempt to treat the more serious 
forms of disease, but that the information here given will prove most 
valuable in preventing sickness, in accidents and other emergen- 
cies, and by enabling all to better cooperate with the physician in his 
best efforts to save life. If the work adequately meets, as we 
trust it will, the needs of those for whom it was written, we shall not 
consider that our long and laborious task has been in vain. 



Aatf)ors. 



Ida C. Barnes, A.B., M.D., member of the American Medical Association; Alumnae 
Association of the Women's Medical College of Pennsylvania; Western Surgical 
and Gynecological Association; Kansas Medical Society; Ex-President of the 
Topeka Academy of Medicine and Surgery; Resident Physician of the Woman's 
Hospital of Philadelphia, 1S90-91; Surgical Lecturer to the Woman's Medical 
College of Kansas City. 

Louis C. Duncan, M.D., Professor of Anatomy, Kansas Medical College; Late Assis- 
tant Surgeon U. S. Volunteers. 

B. D. Eastman, M.D., State Superintendent of the State Insane Asylum, Topeka, 
Kansas; Professor of Materia Medica and Therapeutics and of Psychiatry, 
Kansas Medical College; member of the American Medico-Psychological 
Association. 

Joseph T. Lovewell, Ph.D., late Professor of Chemistry, Washburn College; 
Chemist of the Kansas State Board of Health. 

Robert S. Magee, M.D., Secretary and Professor of Physiology, Kansas Medical 
College; Secretary of the Topeka Academy of Medicine and Surgery. 

John C. McClintock, A.M., M.D., President and Professor of Principles and Practice 
of Surgery, Kansas Medical College; Surgeon-in-Chief Christ's Hospital, Topeka, 
Kansas. 

Richard E. McVey, M.D., Professor of Dermatology and Venereal Diseases and of 
Clinical Medicine, Kansas Medical College. 

William E. McVey, B.S., M.D., Professor of Laryngology, Rhinology and Diseases 
of the Chest, Kansas Medical College; Editor of the Medical Monograph; 
formerly Editor of the Kansas Medical Journal; Secretary of the Kansas 
Medical Society. 

John E. Minney, A.M., M.D., Professor of Diseases of the Eye and Ear, Kansas 
Medical College; member of the American Medical Association. 

Theodore W. Peers, Ph.B., M.D., Professor of the Diseases of Children, Kansas 
Medical College; member of Kansas Medical Society and of the Topeka 
Academy of Medicine and Surgery. 

W. L. Schenck, A.M., M.D., Ex-Vice-President of the American Medical Association; 
Ex-President Kansas Medical Society; late Professor of Hygiene and Preven- 
tive Medicine, Kansas City Medical University and Kansas Medical College. 

Alfred C. Sloan, D.D.S., Professor of Oral and Dental Surgery, Kansas Medical 
College. 



Contents. 



SANITATION. 

CHAPTER I. 

The Cell — Heredity — The Principles of Hygiene — Camp Life — 
Where to Camp — How to Camp — Personal Habits While 
Camping— Home Life — Healthy Homes — Where to Build or 
Choose a Home — How to Build — How to Grade — How to 
Ornament 21 

CHAPTER II. 

Exercise — Its Purposes and Value — Active Exercise — Nerve 
Force — Will Force — Passive Exercise — Exercise in Child- 
hood — Its Best Forms — Correct Positions — The Gymnasium 
— Rest — L Tissue Building in Children — Moral Trend of Exer- 
cise — Development of Heart and Lungs — Exercise versus 
Corsets — Outdoor Life — Bicycling, Its Advantages and Dis- 
advantages — Proper Saddles and Adjustments — Left-handed 
People — The Athlete — College Athletics 30 

CHAPTER III. 

Germ Life and Its Relation to Disease — Infections — Contagions 
— How Diseases Are Spread — Air-borne Diseases — Water- 
borne Diseases — The Meaning of Cleanliness — Precautions 
— Preventives 49 

CHAPTER IV. 

Air — Its Composition — Nitrogen — Oxygen — Density, Humidity, 
Temperature, Air Currents, Altitude, Climate — Their Influ- 
ence Upon Health — Atmospheric Contaminations — Carbu- 
retted Hydrogen — Carbon Monoxide — Sewer Gas — Organic 
and Inorganic Dusts — Ventilation — Quantity of Air Needed 
by One Person — Standard of Purity — Sources of Supply — 
Ventilating Shafts — Ventilation of Schoolrooms — Injuries 

7 



8 CONTENTS, 

Wrought by Poisonous Air — Novel Methods of Ventilating 
— Relation Between Ventilation and Fuel 52 

CHAPTER V. 

Water — Importance of Pure Water — Sources of Supply — Sedi- 
mentation — Filtration — Modern Sand Filters — The Agency 
of Bacteria in Purifying Water — How Rapidly Water Can Be 
Filtered — Value of Filtered Water — Filter Galleries — Other 
Ways of Purifying Water — Nitrification — Oxidation — Sun- 
light — Heat — Distillation — Will Water Freeze Pure — Worth- 
less Filters — How to Filter Drinking Water — Rain Water — 
How to Filter Rain Water — How to Build Cisterns — How to 
Test Water for Impurities — Bathing — Extent of Bathing in 
Ancient Times — The Roman Baths — When and How to 
Bathe — Drv Baths — Vapor Baths — Sea Baths — Swimming. 
• .-" 65 

CHAPTER VI. 

Diet — W r ays in Which Foods Serve the Body — Why a Mixed Diet 
Is Necessary to Health — Nitrogenous Foods — Non-nitrogen- 
ous Foods — Inorganic Foods — What Salt Does for the Body 
— What Magnesia and Lime Do — Beverages — Advantages 
and Disadvantages of Alcoholic Drinks — The Diet in Health 
— Amount of Food Needed Daily by the Average Man — ■ 
Voight's Investigations — Table Showing the Composition of 
Foods — Heat Producing Foods — Tissue Producing Foods — ■ 
Table Showing the Relative Cost of the Various Kinds of 
Food — Balanced Rations and Bills of Fare — How Long It 
Takes to Digest Food — Beaumont's Table — How to Aid Di- 
gestion 80 

CHAPTER VII. 

The Teeth — Diseases of the Teeth — Importance of Intelligent Care 
of the Teeth — How to Preserve the Temporary Teeth — The 
Dental Arch — Root Absorption — The Causes of Deformed 
Teeth — Common Errors Regarding the First Teeth — Should 
Loose Teeth Be Extracted — How to Secure to a Child a 
Faultless Set of Perfect Teeth — Tooth Powders — Mouth 
Washes — Salivary Calculus or Tartar — The Daily Care of the 



CONTENTS. 9 

Teeth — The Teeth During Sickness and Pregnancy — How to 
Control Toothache 91 

CHAPTER VIII. 

Stimulants and Narcotics — Alcohol — The General Effects of Alco- 
holism — Physiological Changes Wrought by It in the Stom- 
ach, Liver, Heart, Kidneys and Brain — Tobacco — The Ele- 
ments of Which It Is Composed — Their Effects Upon the 
Various Organs — Their Influence Upon the Mind — Plow to 
Overcome the Tobacco Habit — Opium and Morphine — 
Their Action and Effects Upon the Human Body — The Cure 
of the Opium Plabit 96 

CHAPTER IX. 

Disinfection and Disinfectants — The Objects of Disinfection — ■ 
Discoveries by Pasteur — The Causes of Disease — When to 
Apply Disinfectants — The Principles of Disinfection — Dilu- 
tion — Changes in Temperature — Sunlight — Chemical Dis- 
infectants — Carbolic Acid — Cresol — Solutol — Tricresol and 
Creolin — Corrosive Sublimate — Lime — Chloride of Lime — 
Soap and Soda — Sulphur — Formaldehyde — How to Make 
Disinfecting Solutions — What Disinfectants to Use — How to 
Use Them — To Protect Homes — To Disinfect Rooms — Cot- 
ton and Linen Clothing — Woolen Clothing — Bedding — Mat- 
tresses — Furniture — Rugs and Carpets — Furs and Skins — 
Boots and Shoes — Excreta — Privy Vaults — Water Closets — 
Sputa — Corpses — The Mouth and Throat of the Attendant 
— The Clothing of the Nurses and Physician — How to Make 
Home Healthy — Drainage Without Sewers — Disposition of 
Rubbish — Patent Disinfectants no 

MATERIA MEDICA. 

Explanations — The Terms Employed — General Tonics — Heart 
Stimulants — Antipyretics — Antiseptics — Emetics — Diuretics 
— Cathartics — Purgatives — Chologogues — 'Hydrogogues — 
The Safest Cathartics and How to Take Them — Hypnotics — 
Anthelmintics — Miscellaneous Remedies — Weights and 
Measures — The Administration of Medicines — Medicinal 



10 CONTENTS. 

Dose List — How to Ascertain Doses for Children of Differ- 
ent Ages 125 

NURSING. 

Importance of Good Nursing — The Nurse — The Physician's Or- 
ders — Personal Care of the Patient — How to Bathe the Sick 
— The Care of the Bed — How to Change Sheets — The Draw- 
sheet — Bed Sores — How to Prevent Them — How to Cure 
Them — The Sick Room — Its Location, Ventilation, Temper- 
ature and Furniture — The Care of Infectious Diseases — The 
Care of Contagious Diseases — The Disinfection of Corpses — 
When Public Funerals Are Unsafe — How to Observe Symp- 
toms — The Preparation of Foods — The Degrees of Heat Re- 
quired to Properly Cook Different Kinds of Food — The Diet 
in Wasting Diseases — The Diet in Diseases of the Stomach 
and Bowels — The Administration of Food — Rectal Feeding 
— Bills of Fare for the Convalescent 155 

EMERGENCIES. 
CHAPTER I. 
Poisoning — Knowledge of Poisons — Modern Uses of Poisons — 
Classes of Antidotes — Quantity of Poison That Will Cause 
Death — Special Poisons — Sulphuric Acid — Hydrochloric or 
Muriatic Acid — Nitric Acid — The Alkalies: Caustic Soda 
and Caustic Potash — Ammonia — Arsenic: Fowler's Solu- 
tion, Rough on Rats, Fly Poisons, Paris Green, London Pur- 
ple, Arsenical Wall Papers, Arsenical Colored Candies, Im- 
pure Subnitrate of Bismuth — Lead : Lead Acetate or Sugar 
of Lead, Lead Subacetate or Lead Water, Lead Carbonate or 
White Lead — Mercury: Mercuric Chloride, Mercurous 
Chloride, Bichloride of Mercury or Corrosive Sublimate, Red 
Oxide of Mercury or Red Precipitate, Sulphide of Mercury 
or Vermilion — Phosphorus 175 

CHAPTER II. 
Aconite, Monk's Hood, Wolf's Bane, Blue Rocket — Belladonna, 
Atropine — Stramonium, Thorn Apple, Jimson Weed 
— Hyoscyamus, Hen's Bane — Hydrocyanic Acid, Prussic 



CONTENTS. 11 

Acid — Conium, Poison or Spotted Hemlock — Opium: Ex- 
tract of Opium, Dover's Powder, Tincture of Opium, Pare- 
goric, Morphine, Codeine — Cupric Sulphate or Blue Vitriol, 
Verdigris or Copper Acetates — Cocaine — Nicotine — Strych- 
nia, Nux Vomica — Digitalis, Foxglove — Chloral, Chloral 
Hydrate — Carbolic Acid — Phenol. Zinc Chloride — Iodine — 
Poison Ivy, Poison Oak — Mushrooms — The Ptomains — Tur- 
pentine — Objects Swallowed : ... 184 

CHAPTER III. 
Accidents — Drowning — Asphyxia — How Soon Death Occurs — 
How to Get the Water Out the Lungs — How to Restore 
Breathing — Satterthwaite's Method — Sylvester's Method — 
Stimulants — Plow to Treat Suffocation — Frost Bites — Sun- 
strokes, Heatstrokes — Burns and Scalds — Extent to Which 
One May Be Burned and Recover — Lightning and Electric 
Shocks — Bites and Stings of Insects, Spiders, Tarantulas, Etc. 
— How to Relieve the Pain — The Bites of Serpents — The 
Dangerous Snakes of North America — Their Poison Appa- 
ratus — How to Use Intoxicants in Treating Snake Bites — 
Hydrophobia — Its Symptoms in Dogs — Its Symptoms in 
Man — Popular Errors — The Dangers from Using a Mad- 
stone — What to Do When Bitten by a Rabbid Animal — The 
Pasteur Treatment — Principles Upon Which It Depends. 194 

BACTERIA. 

The Discovery of Bacteria — How They Grow and Multiply — The 
Germ Causation of Disease — The Henle and Koch Laws — 
Antitoxin Treatments — Definitions — Spores and Their Tenac- 
ity of Life — Universal Prevalence of Bacterial Germs — How 
Bacteria Produce Disease — The Causes of Fermentation and 
Putrefaction — How Wounds May Be Made to Quickly Heal. 
209 

MINOR SURGERY. 

The Triumphs of Modern Surgery — Pus Germs — Surgical Cleanli- 
ness—The Temporary Dressing of Wounds — The Control 
of Hemorrhage — The Permanent Dressing of Wounds — 
Fractures — Sprains — Dislocations — Bruises — Hernia or Rup- 



12 CONTENTS. 

ture — Hernia in Children — Hernia in Adults — How to Secure 
a Perfectly Fitting Truss — Strangulated Hernia — Rectal Pro- 
lapsus and Procidentia 217 

GENERAL DISEASES. 
CHAPTER I. 
Introduction — The Stomach, Its Construction, Size and Muscular 
Movements — Digestion and Its Processes — Mastication — 
Saliva — The Gastric Juices — The Work Performed in the 
Duodenum — The Pancreatic Fluid — The Bile — How the 
Various Nutrients Find Their Way Into the Blood — Indiges- 
tion — How to Find the Cause of a Digestive Trouble — Im- 
proper Methods of Eating and Drinking — A Cause of Big 
Abdomens — Inaction of the Stomach — Chronic Dyspepsia — 
Ulcer of the Stomach — Cancer of the Stomach — Constipation 
— Acute Diarrhea — Treatment for Adults — Treatment for 
Infants — Chronic Diarrhea — Dysentery — Cholera Morbus — 
Colic — Intestinal Obstruction — Sea Sickness — Appendicitis 
and Typhlitis — Peritonitis, Inflammation of the Bowels. .235 

CHAPTER II. 
Typhoid Fever — Malarial Fever — Influenza, La Grippe, Grip — 
Diphtheria, Membranous Croup — Variola, Small-pox — Vac- 
cinia, Cow-pox — Yellow Fever 259 

CHAPTER III. 
The Liver — Its Size, Shape and Position — What It Does for the 
Body — Its Mechanism, Sensitiveness and Liability to Disease 
— Acute Congestion of the Liver — Chronic Congestion — 
Biliary Concretions, Hepatic Colic or Gall Stones — Icterus or 
Jaundice 306 

CHAPTER IV. 
Rheumatic Fever or Acute Rheumatism — Chronic Rheumatism — 
Myalgia or Muscular Rheumatism— Rheumatoid Arthritis or 
Deforming Rheumatism — Gout — Diabetes — Obesity or Cor- 
pulence — Acute Nephritis or Bright's Disease — Nephrolith- 
iasis, Gravel or Kidney Stone — Contracted Kidney — The 
Dropsies 317 



CONTENTS. 13 

CHAPTER V. 
The Heart — Anatomy and Physiology — The Blood — Of What It 
Is Composed— What Its Red Cells Do— What Its White Cells 
Do — Incorrect Ideas Regarding the Heart — Children Who 
Are Born with Defective Hearts — Pericarditis — Endocarditis 
— Malignant Endocarditis — Diseases of the Valves — Hyper- 
trophy or Enlargement of the Heart — Dilatation — Heart 
Failure — Rupture of the Heart — Degenerations of the Heart 
Tissues — Palpitation — Angina Pectoris — Diseases of the 
Blood and Blood Vessels — Aneurism — Varicose Veins — Ar- 
teriosclerosis-— Anemia — Chlorosis or Green Sickness. . .342 

CHAPTER VI. 
The Lungs — Anatomy and Physiology — Sighing, Hiccoughing, 
Coughing, Sneezing — Bronchitis, Cold in the Chest or Cold 
on the Lungs — Chronic Bronchitis — Asthma or Bronchial 
Asthma — Pneumonia or Lung Fever — Broncho-pneumonia 
— Consumption, Consumption of the Lungs — Pulmonary 
Consumption, Phthisis, Pulmonary Phthisis or Tuberculosis 
of the Lungs — Pleurisy — Empyema 358 

CHAPTER VII. 
The Nose and Throat — The Causes of Colds — The Prevention of 
Colds — Acute Rhinitis, Coryza or Cold — Chronic Rhinitis or 
Catarrh of the Nose — The Catarrh of Childhood — Catarrh in 
Adults — Dry Catarrh — Common Catarrh — Adenoid Growths 
— The Pharynx, Palate, Uvula, Fauces and Tonsils — Diseases 
of the Pharynx — Enlarged Tonsils — Follicular Tonsilitis — 
Pharyngitis, Sore Throat — The Voice — The Larynx or Voice 
Box — The Epiglottis — The Vocal Cords — How to Control 
the Voice in Singing or Public Speaking — Diseases of the 
Larynx 381 

CHAPTER VIII. 
The Eye and Ear— How We See and Hear — The Eye — Twitch- 
ing Eyelids — Bright Flashes — Lumps in the Eyelids — Sties — 
Conjunctivitis — Contagious Diseases of the Eye — Pterigium 
— Cateract — How to Find the Cause of an Eye Trouble — 
Epiphora — Photobia — Crabs — Ulcers — Infantile Sore Eyes — 



14 CONTENTS. 

Slight Ailments of the Eye — Dirt, Pieces of Cinder or Steel, 
or Other Foreign Bodies in the Eye — Things Not to Be Done 
to the Eye — The Light of Schoolrooms — How to Tell When 
the Eyes Need Glasses. 
The Ear — The External, the Middle and the Inner Ear — Can 
Deafness Be Cured — Incorrect Ideas About the Ear — Ear- 
ache — Boils in the Ear — Ear Remedies — How to Get Ker- 
nels, Insects or Other Foreign Bodies Out the Ear — Things 
Not to Do 400 

CHAPTER IX. 
Intestinal Parasites — The Tape Worm — How It Reproduces Its 
Kind — The Egg, Embryo, Larva, Cyst, Hydatid — How to 
Protect Domestic Animals — How Tape W 7 orms Enter the 
Human Body — Their Quick and Enormous Growth — The 
Age to Which They Live — Their Wonderful Fecundity — The 
Real Danger Not from the Worms — Ascaris Lumbricoides or 
Round-worms — The Most Common and Next to the Largest 
Intestinal Parasites — The Thread-worm, Seat-worm or Pin- 
worm — Trichina Spiralis — The Bladder-worm — The Gid- 
worm — Precautions — How the Danger Is Increased by Rats 
and Dogs — Fertilizers Which Should Never Be Applied to 
Pastures and Gardens 418 

DISEASES OF CHILDREN. 

CHAPTER I. 
Infancy — A Healthy Child — Color at Birth — Size and Weight — ■ 
Shape and Proportions — Maternal Impressions — Malforma- 
tions — Birth-marks — Training — Age at Which Discipline 
Should Begin — Nursing — Its Regularity and Frequency — 
Quantity of Milk Required — How to Increase or Diminish 
the Mother s Milk — How to Change Its Quality — Where the 
Baby Should Sleep — How Much and in What Positions It 
Should Sleep — The Frequency, Temperature and Duration 
of Its Bath — How It Should Be Bathed — Defecation — Im- 
portance of Regularity, and How It May Be Secured — The 
Right Temperature for a Baby — Improper Ways of Warming 
a Child — Exercise — When and Where to Be Taken. . . '. .431 



CONTENTS. 15 

CHAPTER II. 

Infant Feeding — Artificial Foods — Why Cows' Milk Is Unsuitable 
for an Infant's Food — How to Modify It — Artificial Diges- 
tion — Digestive Tablets — Peptonizing Compounds — Objec- 
tion to the Use of Predigested Milk — How to Find a Milk 
that Will Agree with the Baby — Cereals and Lime Water — 
Age at Which an Infant Should First Have Starchy Food — 
Condensed Milk — Its Defects — The Dangers from Its Use — 
Cereal Foods Partly Digested by Cooking — Cooked Cereals 
with Condensed Milk Added — Beef Juice — W'hite of Egg — 
Whey — How to Feed to Aid Digestion — How to Create a 
Relish for Any Nutritious Food — Sterilized Milk — Pasteur- 
ized Milk — Flints Upon the Preparation of Food — Flow Long 
an Infant Should Be in Taking Its Meals. 

Dentition — Condition of the Teeth at Birth — Disorders Associated 
with Teething — Age at Which the Various Deciduous Teeth 
Appear — Precautions Required — Early Care of the Teeth — 
The Permanent Teeth 442 

CHAPTER III. 
Stomatitis — Its Catarrhal, Ulcerative, Aphthous and Gangerous 
Forms — Thrush — Spasmodic Croup — Acute Dyspepsia — 
Gastralgia or Gastric Fever — Harmless Vomiting — Danger- 
ous Vomiting — Vomiting as a Symptom of Disease — Evacu- 
ations of the Bowels — Appearances of the Feces Indicating 
Diseased Conditions of the Bowels — Meaning of Blood in the 
Feces — Colic — Constipation — The Diarrheas — Catarrhal In- 
flammation of the Intestines — Summer Complaint — Cholera 
Infantum 452 

CHAPTER IV. 
Scarlet Fever — Rubeola or Measles — Rotheln or German Measles 
— Varicella or Chicken-pox — Parotitis or Mumps — Pertussis 
or Whooping Cough — Scrofula — Richitis or Rickets .... 473 

OBSTETRICS. 
CHAPTER I. 
Preliminary Considerations — Who Should Not Marry — Mental 
and Physical Fitness — Pelvic Anatomy — Pelvic Deformities 
— The Organs of Generation — The Uterus, Fallopian Tubes, 



16 CONTENTS. 

Ovaries — The Relation of Ovulation and Menstruation — Fer- 
tilization of the Ovum — Why the Child Partakes of the Char- 
acteristics of Both Parents — Stages of the Embryo and Fetus 
— Degree of Development in Each Month of Pregnancy . . 493 

CHAPTER II. 
The Changes in the Maternal Organism Caused by Pregnancy — 
The Diagnosis of Pregnancy — The Relative Value of the 
Signs of Pregnancy — Maternal Impressions — The Duration, 
Hygiene and Management of Pregnancy — Conditions of the 
Uterus and Its Appendages — Complications During Preg- 
nancy^-Disorders of the Nervous System — Nausea and 
Vomiting — Infectious Diseases During Pregnancy 506 

CHAPTER III. 
Abortion — Its Causes and How to Avoid Them — Extra-uterine 
Pregnancy — Diseases of the Fetus — Management of the Fetus 
— Normal Labor — Preparation of the Room — Preparation of 
the Bed — Preparation of the Patient — Other Safety Meas- 
ures — The Care of the Mother — -The Care of the Child — The 
Diet of the Mother — Nursing the Child — Artificial Feeding — 
The Child's Clothing 525 

CHAPTER IV. 
Convalescence — Effects of Childbirth — Puerperal Infection — 
Child-bed Fever — Failure of the Uterus to Return to Its Nor- 
mal Conditions — Incontinence of Urine — Nervous Compli- 
cations — Sore Nipples — Abscess of the Breast — Changes in 
the Milk — When to Wean the Child — Weight — Respiration 
— Digestional Secretions — Development of the Nervous 
System — Pathology 544 

DISEASES OF WOMEN. 
CHAPTER I. 
Heredity — Changes That Can Be Wrought by Physical Culture 
— The Girl — Her Diet — Clothing — Sexual Development — 
Mental Development — Menstruation — Retarded Puberty 
— Malformation of the Ovaries — Malformations of the 
Uterus — Chlorosis 561 



CONTENTS. 17 

CHAPTER II. 
The Active Period of Life — Its Characteristics and Diseases — Con- 
trasts in Masculine and Feminine Development — The Femi- 
nine Brain and Nervous System — Woman's Recuperative 
Power — Sexual Instinct — The Danger from Uncontrolled 
Passion — Natural and Sexual Selection — The Relations of 
the Sexes . . 57 2 

CHAPTER III. 
General Means Employed in the Treatment of Disease — The Uses 
of Water — Electricity — Exercise — Rules for Muscular Exer- 
cise for Failure of Menstruation — Rules for Exercise for Dis- 
charges of Blood Between the Regular Periods — Swedish 
Movements — Massage — Diet in Disease — Fluid Diet — 
Forced Feeding — Vegetable Diet — The Spare Diet — The 
Diet for Obesity — The Diet for the Aged — The Power of 
Mind Over Disease 579 

CHAPTER IV. 
Derangements of Menstruation — Hemorrhage — Nervous Exhaus- 
tion — Derangements of the Sexual Functions — Acute In- 
flammation of the Pelvic Organs — Chronic Inflammation of 
the Pelvic Organs — Metritis — Endometritis — Cervicitis — 
Congestion of the Ovaries — Chronic Ovaritis — Inflammation 
of the Fallopian Tubes 592 

CHAPTER V. 
Displacements of the Uterus — Anteversion — Anteflexion — Retro- 
version — Retroflexion — Prolapsus — Diseases of the External 
Genitals — Vulvitis — Pruritis or Itching of the Vulva — Hyper- 
esthesia — Vaginitis — Uterine Fibroids, or Tumors of the 
Uterus — Cancer 606 

CHAPTER VI. 
Diseases of the Urinary Organs — Neuralgia of the Bladder — In- 
continence, or Lack of Power to Retain Urine — Paralysis of 
the Bladder — Organic Diseases of the Bladder — Congestion 
of the Bladder — Hemorrhage from the Bladder — Cystitis, or 



18 CONTENTS. 

Inflammation of the Bladder — Various Abnormal Conditions 
— The Menopause — Inflammation of the Uterus After the 
Change in Life — Falling of the Uterus — Complete Prolapsus 
— Dilatation of the Pelvic Veins .617 

DISEASES OF THE SKIN. 
CHAPTER I. 
Anatomy of the Skin — The Scarf Skin — The Papulary and Retic- 
ular Layers of the True Skin — Subdermic Tissue — The Oil 
Glands — The Sweat Glands — The Blood Vessels of the Skin 
— The Muscles of the Skin — Pigmentation — Terms Em- 
ployed in Describing Skin Diseases 629 

CHAPTER II. 
Diseases of the Sebaceous Glands — Comedo, Black Heads, Flesh 
Worms — Milium, Grutum — Steatoma, Wens — Seborrhea — 
Acne Vulgaris — Psoriasis — Lichen Planus — Urticaria, Nettle 
Rash, Hives — Flerpes Simplex, Fever Blisters — Herpes Zos- 
ter, Shingles — Miliaria Rubra, Prickly Heat — Papilloma — 
Verruca, Warts — Eczema, Tetter, Salt Rheum — Dermatitis, 
Inflammation of the Skin — Drug Eruptions — Erythema Sim- 
plex — Erythema Intertrigo, Chafing — Erythema Multiforma, 
Blush — Pediculosis, Louisness — Head Lice — Body Lice — 
Crabs — Scabies, Itch — Cimex Lectularius 633 

CHAPTER III. 
Tinea Trichophytina, Ring-worm — T. Capitis, Ring-worm of 
the Scalp, Scald Head — T. Circinata, Ring-worm of the Body 
— T. Sycosis, Ring-worm of the Face, Barber's Itch — T. 
Cruris, Ring-worm of the Crotch and Axilla — T. Unguium, 
Ring-worm of the Nails — Chilblains — Clavi, Corns — Bun- 
ions — Onyxis, Ingrowing Nail — Onychia, Run-around — 
. Whitlow, Felon — Nevus Pigmentosus, Mole — Furuncles, 
Boils — Carbuncles — Anthrax, Malignant Pustule — Erysipe- 
las — Lentigo, Freckles — Chloasma, Liver Patches — Disorders 
of the Sweat Glands — Anidrosis, Defective Sweat — Hyperi- 
drosis, Excessive Sweat — Bromidrosis, Offensive Sweat — 
Pruritus Ani, Itching Piles . 659 



CONTENTS. 19 

CHAPTER IV. 

The Hair — Its Component Parts — The Follicle — The Root 
Sheath — Color — Curl — Care of the Plair — Hair Tonics — 
Hair Dyes- — Alopecia, Baldness — Premature Alopecia — 
Senile Alopecia — Alopecia Areata 681 

VENEREAL DISEASES. 

Introduction — Syphilis, Pox — Gonorrhea, Clap — Masturbation, 
Onanism, Self-abuse, Self-pollution — Seminal Losses. . . .687 

DISEASES OF THE NERVOUS SYSTEM. 
CHAPTER I. 
Introductory — Inanimate Machinery — The Human Machine — 
The Nervous System — Gray and White Matter — Cerebro- 
spinal Axis, Cranial and Spinal Nerves— Nerve Terminals- 
Subdivisions of the Brain — The Cerebrum — The Cerebellum 
— The Pons and the Oblongata — Decussation of Nerves — 
Motor Nerves — Sensory Nerves — Surface of the Brain — 
Nerve Trunks — Cranial Nerves — Spinal Nerves — Centers of 
Nervous Action — Brain Centers — Spinal Centers — Reflex 
Action — Investing Membranes and Blood Vessels — Flow 
Nerves Are Formed 703 

CHAPTER II. 
Regeneration and Repair — Malformations of Development — In- 
flammation — Meningitis — Degenerations — Tumors and Ad- 
ventitious Products — Vascular Disturbances — Functional 
Diseases — Predisposing Causes — Exciting Causes — Develop- 
mental Influences — Habits and Social Condition 720 

CHAPTER III. 
Diseases of the Peripheral Nerves — Neuralgia — Neuralgia of the 
Head — Neuritis — Multiple Neuritis — Facial Paralysis. . .728 

CHAPTER IV. 
Diseases of the Spinal Cord and Oblongata — Myelitis, or Trans- 
verse Inflammation of the Cord — Infantile Spinal Paralysis — 
Acute Ascending Paralysis — Spinal Hemorrhage — Progres- 



20 CONTENTS. 

sive Muscular Atrophy, or "Wasting Palsy" — Locomotor 
Ataxia— Traumatic Affections of the Cord — Spinal Sclerosis 
— Bulbar Paralysis — Pseudo Hypertrophic Muscular Paraly- 
sis — Intracranial Hemorrhage, Embolism and Thrombosis. 

739 

CHAPTER V. 

Diseases of the Cerebrum, or Larger Brain — Cerebral Palsies of 
Children — Tumor of the Brain — Hydrocephalus, Dropsy of 
the Brain, or Water on the Brain. 

Diseases of .the Cerebro-spinal System and Its Membranes — 
Meningitis — Suppurative Meningitis — Cerebro-spinal Menin- 
gitis — Tubercular Meningitis — Lead Poisoning. 756 

CHAPTER VI. 
The Neuroses — Epilepsy, Falling Sickness, Fits — Chorea, St. 
Anthony's Dance, St. Vitus' Dance — Hysteria — Somnambu- 
lism, Trance, Catalepsy, Night Terrors, Hypnotism, Etc. — 
Paralysis Agitans, or Shaking Palsy 764 

CHAPTER VII. 
Nervous Diseases of Germ Origin — Tetanus — Hydrophobia. 
Nervous Symptoms — Vertigo — Headache — Insomnia or Sleep- 
lessness — Coma — Fainting 782 

INSANITY. 
CHAPTER I. 
Insanity Caused by Defect in Brain Development — Idiocy — Im- 
becility — Feeble-mindedness. 
Insanity Caused by Brain Disease After Development — Melan- 
cholia — Mania — Paranoia — Dementia — Paretic Dementia — 
Illusions, Hallucinations and Delusions Distinguished from 
Insanity — General Considerations— Prevention 795 



SANITATION. 

By W. L. Schenck, A.M., M.D. 

CHAPTER I. 

THE CELL. 

All life reaches back through a past eternity, and forward 
forever. 

Science teaches that, since the first created pair, all life be- 
gins in a cell evolved through the reproductive tissues of a 
parent pair of the same or allied species. Wherever we find a cell, 
we know there was a pre-existent cell. Every embryonic cell, 
a cell formed by the union of a germ and sperm cell, if higher than 
an ameba, is endowed with power to proliferate and differentiate 
other cells, to produce cells like and unlike itself, until it has 
developed all the various types of cells found in the organism from 
which it sprang. 

Physiological]}-, the purpose of all life is the reproduction and 
perfection of life. All the functions of the body begin and end 
in the microscopic entities out of which it is built, and, although 
there is division of labor, each works for the good of all and all 
work as a unit to effect a common purpose. For ages but one 
life was supposed to be in the body. Now we know that life is 
a sum of vital units, and that down among these little lives all 
the living matter of the body, its protoplasm, is prepared, or 
created, and that each nucleus and nucleolus produces a protoplasm 
of special chemical constitution and organic function — changes 
dead into living matter of special type for special purpose, each 
cell doing its own work in its own way. Were other evidence re- 
quired to demonstrate the existence of an individual life in each 
cell it is found in the fact that every cell possesses the power to 
create other cells like itself, and transmit to them both its improved 
and debased conditions. 

As the reproduced cell is born of the varied activities of all 
the ceils of the body it must partake of their peculiarities. This 

21 



22 SANITATION. 

power of transmitting inherited and developed peculiarities is 

called heredity. • 

HEREDITY. 

All developed peculiarities are hereditary, but changes 
wrought by accident, or the surgeon's knife, are not. Thus the 
Jewish rite, performed ever since the age of the lawgiver on the 
eighth day after birth, has wrought no inherited change in the 
circumcised organ. Disease is not and cannot be inherited, but, 
as we have seen, special tissue types are hereditary, and must 
therefore, under favoring circumstances, be predisposed to the 
diseases to which they yielded in the ancestor. Take courage, 
then, for by guarding against these tendencies and observing the 
laws of health, your chances for dying of old age are good, even 
though your parents were consumptives, but this fortune will 
require greater care and prudence on your part than is needed by 
the average child of strong and vigorous parents. 

If, through the thousands of generations in which spirit has 
dwelt in flesh, man had wisely used his intellectual and moral 
faculties, the millennium would no longer be the hope of a far- 
off future. So constant, however, have been his violations of 
the laws of life that, but for his wonderful recuperative power, 
he would long ago have found a place among the extinct species 
of the geologic past. Too often he has lived wholly in his animal- 
isms, has neglected or disregarded the laws of development, or 
become an ignorant slave of passion. He has carefully developed 
grasses and grains, flowers and fruits, and the animals that min- 
ister to his comfort and pleasure, but neglected the improvement 
of his own race, perhaps, because such improvement required 
greater effort, self-denial and self-control. 

Every stock raiser knows that the improvement of his cattle 
and horses lies in judicious mating, and gives to it careful thought. 
With man, too often, fancy, caste, money, lust, are the chief 
considerations. The procreative act is the most momentous in 
the life of man, each new generation increasing the magnitude of 
ancestral errors, yet how many give to it as little intelligent 
thought as wild beasts of the plains. 

THE PRINCIPLES OF HYGIENE. 

The laws of life and health date back to the creation of the 
universe. 



SANITATION. 23 

He who created life made laws for its procreation, develop- 
ment and preservation ; laws which, understood and obeyed, give 
health and fullness of life ; disobeyed, whether ignorantly or know- 
ingly, disease, misery and premature death. Sanitary science 
embraces all the means by which healthful life is preserved. Two 
antagonizing forces are ever present, life and death. While the 
one is continually vitalizing the material out of which the body 
is built, the other constantly destroys the vitalized atoms. In 
perfect health there seems no antagonism between these ever 
opposing processes; the new steadily replaces the old, in more 
potential form, until development is perfect, when destructive 
gradually trench upon constructive forces until the body comes 
to the grave, "like a sheaf of corn fully ripe," and the spirit soars 
on angel wings. This should not occur until man has reached 
his fivescore years, for the law of animal life is that it shall extend 
to five times its developmental period. 

A physiological balance between the building and destroying 
activities is the chief concern of hygiene. The cells destroyed 
by the attrition of use must be replaced or there will be atrophy, 
and, when destroyed, they must be remo\^ed from the body or 
they will become toxines (poisons), deranging all the activities 
of life. The toxines of these dead cells will vary as widely in 
character as the cells from which they came, and in effect, as 
widely as the cells upon which they act. Let the removal of dead 
tissues be prevented and there will be auto-infection (poisoning 
from within), and diseases of varied type, for disease is a logical 
sequence of hindered or deranged action among the minute ele- 
ments of the body. Health lies in the physiological activity of 
these elements. Keep the body and every surrounding pure 
through perfect cleanliness, and, with proper nutrition, healthful 
exercise, regular habits and a cheerful mind, you need not fear 

disease. 

CAMP LIFE. 

Camp life was presumably man's first estate. How long 
before written history the race had camped in caves and wigwams 
no man knows. Permanent homes and city building are the 
evolution of the ages. The hygiene of camp life, whether of those 
who dwell in tents for a summer outing, a camp meeting, a militia 
service, or of armies in the tented field, is based upon immutable 
laws, and is, therefore, much the same everywhere. 



24 SANITATION. 

The selection of a camping place is of the first importance. 
The soil should be dry, clean and well drained. When practicable 
there should be a gravelly substratum, and a few large trees to 
shield from sun and storm, but no underbrush to interfere with 
the free circulation of the air. There should be an abundance 
of pure water and the camp must be so situated as not to re- 
ceive dampness — out of line with winds that bear away the evap- 
oration of rivers, lakes and the like. Latrines should be made 
at convenient distances from the camp, and where their odors 
will not reach it or their contents contaminate the water supply. 
Into them a few shovelfuls of fresh earth, to cover all excrementi- 
tious matter, should be thrown every morning and evening. 

The camp should be kept as clean as a lady's parlor. The 
fire furnishes a fit place for the disposal of all waste, and should 
be kindled every morning and evening when the air is damp or 
chilly. The tents should be well aired every day, their occupants 
protected from the chill of night by an abundance of proper 
clothing, and, as night approaches, extra shawls and coats should 
be pressed into service. By a careful avoidance of the damp and 
chill of night air there need be no fear of microbes or periodic 
diseases, neuralgias, etc. 

The food supply should be inspected every morning, and the 
inspector should know that the cook employs the best methods. 
For drinks, aside from pure and sparkling water, iced tea, lemonade 
and ginger ale are always acceptable, while coffee and camp life 
are inseparable. It is well to have some alcohol in camp to be 
used in cases of shock, to relieve the first sense of exhaustion, or 
in case of snake bites, to check the poison, but, as a regular bev- 
erage, it destroys the equilibrium of the organism and tends to 
various diseases. 

All habits should be regular, and one-third of the time given 
to sleep. This rule should be very carefully observed by those 
who are seeking health. There should be a daily bath, which, if 
taken in a lake or stream, should not be prolonged beyond fifteen 
minutes, and should be followed by free friction with dry towels. 
It should never be taken within two hours after a full meal. 
Regular hours should be set apart for exercise, which must never 
be excessive in hot weather, or at any time with those seeking 
health. Let there be games, books, etc., to prevent ennui, and all 
business cares be left at home, or, more properly, in the business 



SANITATION. 25 

house, where they belong. Remember that in an outing the chief 
thought should be freedom from care and a full enjoyment of the 
pure environment and abandon of country life. A competent 
person, clothed with authority to command obedience to the laws 
of health, should be appointed to select the camping place and 
to daily inspect the camp. 

In the military service of regular armies all officers are pre- 
sumed to comprehend their duties and to enforce obedience with 
military rigor, but in the summer camp of state troops there is 
often a deplorable ignorance of all that pertains to health, and, in 
consequence, much unnecessary sickness. This was especially 
true of the rapidly improvised armies of the Great Rebellion, and 
in the late war with Spain, the fearful penalties suffered in the 
camps of our volunteers for being officered by men criminally 
ignorant upon sanitary matters, are too well known to require 
more than a mention here. Too often the colonel thought the 
regiment belonged to him and that his straps made him equal to 
its hygiene. While the work of the surgeon is very different from 
that of the commander, there will be no conflict of authority 
when each understands his duties. Where no exigency exists the 
surgeon should always select the camping place, and supervise 
all that pertains to its healthfulness, and his directions should be 
cordially seconded by the commandant. 

HEALTHY HOMES. 

By healthy homes we mean homes in which shall be built, 
for God and humanity, strong, useful, happy lives ; homes whose 
environment shall keep away the gaunt arm of disease, secure 
perfect physical development, and make of the body an instru- 
ment whose passions, appetites and desires are in subjection to 
the higher spiritual life. Such a home will not only be brightened 
by the light of the sun, but illumined by intelligence, purity and 
love. The soil on which it is built will be thoroughly drained by 
proper tiling, and its cellar will be dry and well ventilated. Sun- 
light will enter every room at some hour during the day, and trees 
that are so near the house as to prevent the free admission and 
circulation of air will be removed. Let beautiful trees surround 
the home, but not be so near as to interfere with sunlight and air. 

There must be pure water in abundance, and it must be used 
not only for drink, but to keep clean the person and all surround- 



26 SANITATION. 

ings. Every home should have a bathroom, so appointed that 
its use will be a luxury. 

It may cost something to secure a healthy home, but the 
joy of rosy-cheeked, rollicking childhood, and the health and hap- 
piness of the family, are not to be weighed against gold. The 
anxiety and anguish that fill the home where the rose is sup- 
planted by the lily, where suffering and sadness displace the glee 
and laughter of healthy, happy children, where doctor's, nurse's 
and undertaker's bills take the place of those of the carpenter, 
plumber and gardener, lead to the conclusion that healthy homes 
are the cheapest. 

LOCATION AND CONSTRUCTION OF THE HOME. 

The building spot must be well drained, not on a clay sub- 
soil, which is often damp, and never on "made soil," which always 
contains death-dealing elements. Hilltops and hillsides are likely 
to be well drained and dry, but valleys are usually damp. On the 
first range of hills to the windward of rivers, lakes and ponds, con- 
stant evaporation often settles. The occupants of homes built 
upon such hills will suffer from palludal fevers, while those in the 
valley below may escape, the dampness passing over their heads. 
The neighborhood of swamps, lagoons and millponds should be 
avoided. If that cannot be, let the home be on the side from 
which the prevailing winds blow. 

We quote the following from Bishop Haven because it shows 
so plainly the importance of correct location : 

"Two brothers in Vermont, of strong and vigorous stock, 
and giving equal promise of long and useful life, married wives 
corresponding in promise of future activity. They both had 
chosen that healthiest of all callings — farming. One of the broth- 
ers built his house in an open and sunny spot, where the soil and 
subsoil were dry; shade trees and embowering plants had a hard 
time of it, but the cellar was dry enough for a powder magazine; 
the house in all its parts was free from every trace of dampness 
and mold; there was a crisp and elastic feeling in the air of the 
dwelling. The farmer and all his family had that vigorous elas- 
ticity that reminds one of the spring and strength of steel. Health 
and sprightly vigor were the rule, and sickness the rare exception. 
The farmer and his wife, though past threescore, have yet the 
look and vigor of middle life. 



SANITATION. 27 

"The other brother built his home in a beautiful, shady nook, 
where the trees seemed to stretch their protecting arms in benedic- 
tion over the modest home. Springs fed by the neighboring hills 
burst forth near his house, and others by his barns; his yard was 
always green, even in the dryest time, lor the life-blood of the hills 
seemed to burst out all about him in springs and tiny rivulets. 
But, the ground was always wet, the cellar never dry, the walls 
of the rooms often had a clammy feel, the clothes mildewed in the 
closets, and the bread molded in the pantry. For a time their 
native vigor enabled them to bear up against these depressing in- 
fluences ; children were born of apparent vigor and promise, but 
these one by one, under the touch of diphtheria and pneumonia, 
sank into the arms of the dreamless twin brother of sleep. The 
mother went into a decline and died of consumption before her 
fiftieth birthday, and the father, tortured and crippled by rheuma- 
tism, childless and solitary in that beautiful home, which elicits 
the praises of every passer-by, waits and hopes for the dawning 
of that day which shall give him back wife and children, an un- 
broken family, and an eternal home." 

In the city choose a home as far as may be from the sources 
of moral as well as physical pestilence, that there may be sound 
morals with a sound body, for the physical and the spiritual life 
constantly exercise reciprocal influences. 

Let the home be away from pigsties and barns, cess pits, gar- 
bage heaps and sewer openings, and, as much as possible, from 
the dust of the street, and let the saloon, gambling house and 
brothel be far removed. Locate the home near schools, and 
churches, far enough back on the lot to have a lawn, flowers and 
sunshine, with parks and trees along the street, and make it an edu- 
cator in all that is beautiful, ennobling and healthful. Whatever 
debases the intellect and morals tends to physical degeneration, 
and vice versa. 

The evolution of man into higher and yet higher types of 
manhood involves the development, generation after generation, 
not only of the body, but of the spirit that molds it, to its noblest 
possibilities. The home must be an educator in all that is man- 
like, god-like, and never inculcate shiftlessness or helplessness. 
Much of one's education will be obtained away from home, but the 
home should rectify and purify it all. 

As far as practicable, the home should be owned by those 



28 SANITATION. 

who occupy it, and day by day it should be made more attractive, 
so that it will remain forever a green spot in memory — its uplifting 
influence always surrounding those who have known its peace 
and joy. 

In building we must begin at the bottom, remembering that 
the foundation is the most important part of a permanent structure. 
If the location is not dry at all seasons, let the foundation be laid 
double on a solid substratum of asphalt or Roman cement, to 
prevent dampness from below and without. All the walls should 
be double, with an air space between. This space will secure both 
dryness and warmth. Stone and brick houses should be lathed and 
plastered, with an air space between the lathing and the wall. 
If the location be damp, place beneath the timbers a layer of slate, 
imbedded in cement. The house should be at sufficient elevation 
to have three feet of the cellar wall above the surrounding surface, 
that there may be proper cellar ventilation, light and dryness. 

The cellar floor should be laid in asphalt or cement. A damp, 
dark, illy ventilated cellar under the home means pneumonia, rheu- 
matism, consumption, and all disease intensified. It means 
acquaintance with doctors and undertakers. All cellars must be 
kept clean, free from dust and decaying vegetables, and should 
be frequently whitewashed. Sanitary inspection should begin with 
the cellar. Too many cellars are dark and damp. Many have 
rotting wood floors and rough walls whose interstices are deposi- 
tories for all manner of dust and filth, and often, too, they are con- 
taminated by faultily constructed or leaking soil pipes. The 
grounds about the house should slope from it in every direction 
sufficiently to carry away all moisture ; and they should also slope 
away from the well and cistern. 

All outbuildings should be constructed in conformity with 
the laws of sanitary art and science, and before the home is occu- 
pied it should be inspected by a thoroughly competent sanitarian. 
Where there are no sewers, the privy vault should be made of iron 
or water-tight cement, unless placed so far from the house and 
water supply that it cannot possibly contaminate them. It should 
be of moderate size and frequently cleaned. That it may be kept 
pure and aseptic it should receive daily a little dry earth and 
occasionally a quart of the saturated solution of sulphate of iron. 
No cess pit should ever be within one hundred feet from the well 
or cistern, and never on ground higher than the water supply, or 
near the dwelling. 



SANITATION. 29 

Paint, kalsomine, whitewash, all are preferable to paper, but 
if the housewife must gratify her love for the artistic by papering 
her walls with modern designs, let all old paper be removed 
before the new is applied. The common practice of putting one 
coat of paper upon another until many thicknesses have been 
plastered upon the walls to exhale poisons from decaying paste, 
and other chemical reactions, cannot be too strongly condemned. 
All dwelling houses should be painted outside, for paint not only 
beautifies and preserves but helps to secure dryness. 

In no other part of the furnishings is there likely to lurk so 
much danger as in carpets. They should be taken up frequently 
and thoroughly cleaned and aired. Hardwood and painted floors, 
requiring only rugs which can be easily removed and cleaned, are 
much more sanitary. 



CHAPTER II. 



EXERCISE. 



Exercise is any movement of the body tending to change its 
molecular elements. In all organic matter the present is the 
ever-changing, eternal link that binds the future to the past. With 
properly regulated activities each new link should be better than 
the old. Evolution is the law of life, life through never-ending 
changes. Progress requires constant readjustment and renewal. 
This comes through exercise, and the Creator has ordained it 
for every organ of the body and faculty of the soul. We may be 
either slaves or masters, worse or better, through the force of 
habit. New cells may be made superior to the old. The properly 
trained muscle gains strength and skill equal to any emergency, 
and correct mental discipline — well-regulated thought — makes 
each succession of brain cells better than those displaced, until 
the mind is enabled to reach out and up, and grasp and utilize 
laws governing the universe. 

Physiologically, exercise is the wisely regulated activity by 
which, through one of those beautiful compensations so often ob- 
served in nature, both the force expended and the atoms de- 
stroyed are renewed in more potential form. It is the application 
of stored- up force to the generation of greater force. Whether 
life was created merely for the reproduction of species, or for the 
purpose of changing and vivifying matter until a superadded 
spirit shall find through it all its possibilities, up to that final step 
beyond which science cannot go, the continuous change incident 
to exercise is essential to both physical and spiritual health and 
development. The functional activity of the organism destroys 
and removes its atoms while it provides material and stimulus for 
creating their successors. 

Want of exercise, too much exercise, and deficient nutrition, 
all result in defective development and tend to degeneration and 
atrophy. Any movement in an organ is exercise though it be 
deficient, defective or excessive, and exercise in some form is es- 
sential to its life, health and efficiency, is an agency through 

30 



SANITATION. 31 

which nutrients are borne to a part, waste removed, and normal 
activity preserved or restored. 

Exercise is of two kinds — Active and Passive. 

Active Exercise may be defined as muscular movements 
directed by the will. What causes muscular movement, strength 
and endurance? The muscles, as you know, are only a combina- 
tion of cells, which, stripped of their sheaths, will hold little more 
than their own weight, yet the emaciated muscles of an enraged 
maniac are energized by some unseen force until they hold in 
abeyance the strongest men. Though muscle cells are necessary 
to muscular action, there is a power behind them through whose 
potency they are energized. The mind acting upon the will im- 
presses the cells of the gray matter of the brain in some unknown 
way, transmits to the motor nerve centers the impulse which, borne 
to the muscles, gives them power to act in direct proportion to 
the strength and endurance of the mental impression and volition. 
It is evident, then, that back of effective exercise lies the power of 
mind, whose activities stimulate the generation of nerve influence, 
nerve fluid, neurism, whatever that is. Violent or long-continued 
exercise may exhaust the power of generating and disseminating 
neurism, and be followed by atrophy, .paralysis, death, but, under 
proper control and a well-directed will, its force is well nigh bound- 
less. Taken with a little allowance, a man can do what he believes 
he can — what he wills to do. Who pulls with a will wins the 
pennant, and who works with a will in any department of life 
generally achieves success. The lazy lout may have plenty of 
muscle but it is never energized; he may have plenty of brain 
cells, but lives and dies without causing even a ripple in the 
movements of the world. Will power makes the man by enabling 
him to control and energize all the activities of life. Upon it, more 
than upon anything else, depend strength of character and a 
perfect life. 

The body is so marvelously constructed, so fitly joined, that 
impressions made upon any part are in touch with every other 
part. The proper exercise of an organ not only increases its 
possibilities, but more or less affects the whole organism. During 
exercise more air is taken into the lungs — over a third more oxy- 
gen being then absorbed, and a still greater proportion of carbon 
dioxide eliminated. Exercise also increases the frequency and 
efficiency of the heart's action, so that the blood courses more 



32 SANITATION. 

freely to all parts of the body. As a direct result of muscle con- 
traction and relaxation there is glandular activity and vascular 
movement, and what is true of these organs applies with equal 
force to the nervous system, for muscular action not only increases 
blood movement and blood supply, but increases nerve power, con- 
verts stored up energy into force, furnishes the material to replace 
that consumed, and stimulates the replacement. Properly regu- 
lated, it so invigorates the muscle cells, and their associate organs, 
that health and development follow. Improperly applied, either 
exercise or rest may produce pathological changes in the acting 
organ and in remote parts; thus, through well-regulated exercise 
vision grows clear and strong, perception more acute, life more 
joyous, and the vitality of the whole organism is increased ; but 
improperly used, the eye is injured, and diseases developed whose 
effects are not confined to the injured organ. So, by proper use, 
the vocal organs develop until they convey in melodious tones 
the various emotions of the soul, but, improperly exercised, 
cease to be its servants, and may produce far-reaching disease. 

Passive Exercise. — Of the various forms of passive exercise, 
we will mention only massage, which may be defined as a kneading 
of the soft parts of the body ; a series of systematic passive manip- 
ulations. Instinctively we rub or press a part suffering from 
numbness, or other abnormal sensation. As a preventive and 
curative measure it is coextensive with the history of medicine. 
Plutarch tells us that even great Caesar was pinched daily to cure 
or prevent neuralgia. Galen was appointed physician to the 
Pergamos school of gladiators, who were rubbed before and after 
their combats ; and every intelligent horseman makes his groom 
a masseur to his horses before and after racing. The artful "bone- 
setter," who pretends special magnetic powers, has sometimes 
acquired fame through judiciously applied massage. Although 
it lacks will-force, that important element of all perfect exercise, 
where active exercise is impracticable, passive exercise is essential. 
It promotes absorption, increases the volume of the circulation, 
and relieves engorgement, stiffness and pain. 

EXERCISE IN CHILDHOOD. 

As a rule, in childhood and youth, opportunity for exercise 
is the only requirement, but, that each child may receive its full 
benefits, some approved method of physical training should be 



SANITATION. 33 

practiced daily in every school. The playgrounds are often too 
small, but even where ample, some students, usually those most 
in need of exercise, idly stand during the time for recreation. 
Every form of exercise should be made attractive and joyous, that 
the pupils may enter into it heart and soul. We live in our nerve 
centers. Until they are energized, there can be no free action. 
Whatever the form of exercise, it should be easily learned, readily 
practiced, and call into action the whole body. That the im- 
portant organs within the chest may have full development, all 
constriction should be removed. 

Pupils should first be taught to properly sit, to stand erect, 
and to take such postures as will give grace and ease to all their 
movements. Some suppose they stand erect when the chest is 
thrown forward and the back drawn in, so that a perpendicular 
line that touches the chest is several inches in front of the face 
and toes, and one that touches the nates, several inches behind 
the back of the head and heels. Others think they are erect when 
the abdomen is protruded, and a perpendicular line touching it is 
in front of both face and feet ; while a line which touches the 
shoulder is behind the head, nates and heels. Neither is right. 
In the erect position that gives ease in standing and freedom to 
all the organs, a perpendicular line should touch the lips, chest 
and toes, when the feet are at an angle of sixty degrees ; and a 
perpendicular line passing through the body would pass through 
the shoulder, hip and ankle joint ; while one drawn behind the head, 
shoulders and heels would touch only the nates. The head is 
thus carried erect, and the perpendicular lines are nearly at right 
angles with the collar bones. Observing this position for a time, 
it will soon be taken and maintained without conscious effort. 

In sitting the body must also be maintained in an upright 
position by the muscles, and when bent it should be at the hips. 
The position must be changed when the muscles become fatigued, 
but the greater part of the time the body should be erect and 
rest squarely upon the nates. Every position should give perfect 
freedom to the organs within the chest and abdomen. 

In walking or running, the step should be free and swinging, 
the head erect, the shoulders thrown back and the chest forward, 
thus developing grace, comfort, strength and health. AYalking 
and running, combined with a moderate amount of such indoor 
gymnastics as the dumb-bell, Indian club and rowing machine, 



34 SANITATION. 

will give a requisite degree of exercise to all parts of the body. 
When a boy has a woodpile, ax and saw, he can find plenty of 
useful exercise, though it is likely to lack the mental diversion 
essential to the best results. 

Remember that proper exercise means the vigorous use of 
every part of the body, and for perfect results must be coupled 
with joyousness, and that exercise which unduly strains any or- 
gan must be avoided. Hypertrophy and irregular action of the 
heart are frequently caused by excessive exertion. This is espe- 
cially liable to occur in competitive games, where the ambition 
of the player, stimulated by the applause of the multitude, calls 
forth the last ounce of force — an illustration of the influence of 
mind upon muscle. Daily labor, as well as exercise for health, 
should be so regulated that all over-strain shali be avoided. Be- 
fore engaging in active exercise, we should be sure that there 
are no forbidding conditions; e. g., those laboring under valvular 
disease of the heart must not run, row or exercise violently in 
any way. 

Model modes of exercise are found in walking, running, row- 
ing, skating, cricketing, horseback riding, etc. The gymnasium 
has the advantage of furnishing exercise in spite of wind and 
weather, and in exciting all parts of the body. It should always 
be well ventilated. 

REST. 

Rest forms an important part of all systems of exercise, and 
between it and exercise there should be a well-established mean, 
differing at different ages, and for different conditions and indi- 
viduals. Exercise that wears out and removes the developed tis- 
sues of all the organs, secures through rest and proper nutrition 
perfection of form, gives elasticity and grace to every move- 
ment, and confers great power of endurance — the fullness of both 
physical and spiritual life. In the overworked the parts are 
pressed together, from excessive cell destruction, and there is 
loss in height and symmetry. Continued health, vigor and cheer- 
fulness lie largely in joyous exercise, alternated with well-timed 
rest, regardless of the feeling of fatigue, for, while that is a warn- 
ing against its continuance, we should not always wait for the 
warning. 



SANITATION. 35 

TISSUE-BUILDING IN CHILDREN. 

That all organs may be properly exercised from early life, 
the babe should be placed upon the floor and encouraged to kick 
and roll. It should be taught to creep — an exercise natural to 
most children and tending to the development of the trunk and 
limbs. The daintiness which keeps a child from the floor cannot 
be too strongly condemned. In infancy, childhood and youth, 
even down to old age, the chest should be preserved as it is 
found at birth — larger at the lower ribs than at the armpits. 
When the limbs are strong enough to support the body without 
injury, the child should walk, run, romp and roll, both in the 
nursery and upon the lawn. The nurse may find a fit exemplar 
for proper training in the playful puppy, and encouragement in 
the perfect development of all its organs. 

Before the child can walk, it should be given a daily airing 
in the baby carriage, and kept out many hours, properly wrapped, 
of course, in cold weather. It will soon learn to long for its out- 
ing, and, when old enough to go alone, it should spend most of 
its waking hours in the open air. 

At the proper age, a portion of its time should be given 
to work and study, but no work should ever be made a burden 
and no teaching a task. Both should be joyous. Remember 
that: — "All work and no play makes Jack a dull jay." The boy 
t-ires at the woodpile, long before he has had sufficient exercise. 
The "sawing bee/' in which the boys go about helping each other, 
destroys monotony and makes the task more joyous. Work or 
play, to be healthful, should be pleasant. Good humor and a 
willing mind energize the nervous system and cause the genera- 
tion and distribution of sufficient neurism to keep the muscles 
well oiled and free from fatigue. 

One of the best modes of exercise for students and those 
engaged in sedentary occupations, is to keep a ball bounding from 
a wail. When vigorously played by two or more persons, each 
alternately stopping the ball, it will bring all their muscles into 
proper action. 

Tissue renewal and building are the physiological objects 
of aM exercise. To accomplish this the material must be at hand, 
and, that it may be of the right quantity and quality, digestion 
must be good. Like other organic activities, it requires nervous 
energy, which should not be exhausted by active exercise, either 



36 SANITATION. 

physical or mental, immediately before or after meals. For half 
an hour both preceding and following a hearty meal, there should 
never be more than quiet, joyous recreation. 

THE MORAL TREND OF EXERCISE. 

Mental and moral exercise, properly directed, tends to de- 
velop and improve the brain as certainly as correct physical exer- 
cise gives strength and vigor to the muscles. Cherish, then, pure 
thoughts, noble ambitions and right aims, for "As one thinketh 
so is he," and the brain builds on what it feeds. 

We have occasional examples of learned men leaving the 
study for the nursery, and there have been kings who played horse 
with their little ones, but in the hurry of American life parents 
do not find time to play as much as they should with their chil- 
dren. This false economy of time is loss, both to the children 
and the parents. By indulgence in their sports there comes oppor- 
tunity, through an unseen authority and visible example, of forti- 
fying them against the evils incident to all sports and ot wielding 
an unconscious influence that will be a blessing throughout their 
lives. Imbibing the spirit of youth, the parent grows young again 
and keeps young, and, by mingling in their plays, strengthens 
the bonds of affection and acids to the joys of their early days 
memories that will never perish. 

DEVELOPMENT OF THE HEART AND LUNGS. 

Muscular development, as ordinarily understood, is only a 
secondary matter, for the muscles that form the outer coverings 
of the skeleton, however important, are dependent upon the 
health and development of internal organs. It is, therefore, of 
the first importance that we learn their correct use. So intimate 
is the connection between heart and lungs that, however widely 
different their function, they seem but parts of a whole. The 
heart sends the blood from its right side to the lungs for oxidation 
and decarbonization, which, after it has been purified and vivified, 
return it to the left heart for distribution to the organism. So 
these organs go band in hand and, although their action is largely 
involuntary, they are amenable to education. 

When we know that many athletes, whose fine muscular de- 
velopment and feats of strength have excited admiration, die sud- 
denly and in early life from failure of the heart or lungs, and that 



SANITATION. 37 

very many at a more advanced age die of heart or lung trouble, 
we recognize the importance of the question : — How should we 
breathe? Their training did not reach these important organs, 
and the fine superstructure, being without a proper foundation, 
soon crumbled to decay. 

The diaphragmatic muscles assist the lungs in receiving and 
expelling air, and abdominal breathing is natural to both sexes, 
but we must not overrate its importance. It is only a part of this 
vital act. In civilized life very few women breathe abdominally, 
although many are healthy and long lived, yet were not both 
abdominal and thoracic breathing essential to a perfect life, we 
would have been created without the one or the other. 

But how should we breathe? When in the proper attitude, 
with chest free from constriction, take a deep, long breath, con- 
tinued until the lungs seem filled but not strained. By practicing 
this conscious breathing several times each day or hour, as you 
think of it, the lungs will become enlarged, and both respiration 
and pulsation slower and stronger. If persistently practiced it 
will soon cease to be conscious breathing, for the habit of deep, 
full inspirations will become normal, and you will find by measure- 
ment that the expansive mobility of the chest has increased, not 
by building up the muscles about its walls, but by an increase of 
lung capacity and strength. 

In practice, breathing must be both abdominal and thoracic. 
For the former, breathe as if about to lift the body upward and 
forward, and, to exercise the abundant cells of the lower portions 
of the lungs, at the same time lift the abdomen forward. With 
perfect breathing certain movements facilitate lung exercise and 
development. Thus, as you take a ^ong, deep breath, keep the 
arms straight, raise the hands slowly above the head without 
bending the body, and hold the breath while they are brought 
down, then slowly exhale. Another aid in lung development is 
found in bringing the elbows to the level of the shoulders, the 
fingers touching in front of the sternum and on the same level, 
then, carrying them backwards, take in as much air as the lungs 
will hold, retain it while you return the hands to the chest position, 
then slowly empty the lungs. These movements should be made 
deliberately, say ten times a minute, practiced morning and even- 
ing, when partly disrobed, and stopped when there is a feeling of 
fatigue. 



38 , SANITATION. 

EXERCISE VERSUS CORSETS. 

For boys outdoor sports and work usually furnish abundant 
exercise. With girls it is quite different. Their work is generally 
in the house and outdoor sports are too often considered unsuit- 
able, while careful mothers, even among the poor, anxiously re- 
lieve their daughters from all burden bearing. Thus there is 
faulty development of the muscles and ligaments which are to 
keep in place the organs peculiar to their sex. 

In addition to this as soon as they begin to bud into woman- 
hood, when the organs should have ample room for development, 
the fond mother begins to make them "shapely" with corsets, or 
other chest constrictors, thus distressing the lungs, stomach, liver 
and spleen, and pressing down the sexual organs into the cavity 
of the pelvis. In the lives of most women, there come times when 
a tub, table, or other article needs lifting. The first act in all 
efforts of this kind is compression of the walls of the abdomen, by 
contracting the abdominal muscles. The diaphragm, prevented 
by the corset from moving upward, presses the contents of the 
abdominal cavity downward, the poorly developed ligaments give 
way, and there is uterine displacement, with all its varied aches 
and pains, and the neuroses for which it stands. 

Both sexes are built out of similar combinations of vitalized 
elements controlled from nerve centers, and, in the main, what 
is good for the one is good for the other; but woman has some 
peculiarities of structure, constitution and habit, that merit special 
consideration. While she may advantageously take physical 
training, when she finds any form of movement impresses harm- 
fully any part of her organism, it must be moderated until she 
becomes accustomed to it. It has generally been supposed that 
woman's power of endurance is not as great as that of man, but if 
that be true she is an exception in the animal kingdom. Her 
muscles are not as large, but they are energized by a more active 
nervous system. She has been so dominated by the iron heel of 
fashion that her physical system has been handicapped. Perfect 
development requires the free play of all the organs. Though 
Greek statuary shows the perfect conception of the ideal woman as 
possessing strong and ideal proportions, wasp waists have been 
the fashion for centuries, and, among all civilized nations, have 
been so assiduously cultivated that you can scarcely find a woman 
who breathes naturally, both thoracically and abdominally. 



SANITATION. 39 

Although there has been some amendment among women 
of culture, the "butterflies" still fasten their corset cords to the 
bed-post and throw their weight upon them to reduce their waists 
to the smallest possible compass. Few physicians have failed to 
notice women whose floating ribs overlapped the stomach, until 
forced to wonder where they kept that important organ and its 
fellows of the same region — the liver and the spleen — and to mark 
grave disease as a consequence. Nature has assigned a place to 
each organ, and an organ can be displaced only with injury to it- 
self and such displacement of its fellow organs as to invite far 
reaching disease. Most women become indignant when lacing is 
suggested, yet abdominal breathing has become so rare among 
civilized women that some supposedly learned physiologists have 
taught that only thoracic breathing is natural to woman. A little 
investigation, however, shows that the latter is natural only to her 
who is civilized ! 

Those accustomed to the corset complain that when it is left 
off there is a sense of weakness, a lack of support that is uncom- 
fortable. They want it to hold them up — the best possible argu- 
ment against its use. Nature has provided muscles for the sup- 
port of the body, and it is the corset that lias prevented their 
proper growth. In slender, delicate women nothing secures de- 
velopment like freedom from constriction — breathing so as to 
secure chest expansion and the proper use of chest muscles ; and 
nothing so reduces obesity and prevents unseemly protrusion of 
the abdomen as this freedom and exercise. They promote in all 
perfection of form, grace of movement and clearness of skin. 
Sallow complexions, hollow chests, spinal curvatures and pro- 
truding abdomens are the logical results of the corset. Do not 
wear it. 

OUTDOOR LIFE 

Nothing else so perfectly overcomes the irritability and nerv- 
ousness quite common to womankind as outdoor exercise, that 
calls into play all parts of the organism, followed by rest in the 
horizontal position, or so perfectly develops all portions of the 
body, giving grace to form and movement. The idea that work 
is disgraceful is disreputable. The woman who takes pride in 
doing her own housework, who does it with a will, and enjoys 
keeping her home in order, will escape the wear and tear of soul 
and body incident to the management of the average servant, and, 



40 SANITATION. 

in three hours in the morning and two in the afternoon, will do all 
the work of an ordinary house, kept neatly and plainly, and do it 
satisfactorily. Like Bridget, she may dawdle over it all day and, 
feeling it a hardship, soon grow tired and lose the joy and benefit 
of the exercise it furnishes, but by energetic, hopeful, happy work, 
followed by a refreshing bath, clean linen, rest and an afternoon 
airing, she may enjoy perennial health and a form and complexion 
outrivaling those of Venus. 

It has frequently been remarked that, in high, salubrious table- 
land and mountain districts, men are healthier than women — a 
condition due in part to the nervous irritation common to such 
altitudes, but largely to the outdoor life of the men and the se- 
cluded lives of the women. To get the full benefit of pure air 
one must spend much time outdoors. As a class, women lead too 
sedentary lives. 

Walking and running are among the best forms of exercise, 
but women get out of breath from lack of practice. Then, too, 
they have corns and bunions — for pride in small feet is not pe- 
culiar to the Chinese woman — which greatly interfere with grace- 
ful movements and continued exercise on foot. The shoe should 
be large enough and, what is quite as important, should fit the foot. 
If the toes be well turned out in walking, the practice will tend to 
prevent forward contraction of the pelvis. 

BICYCLING. 

Although the bicycle is very popular, and its swift, easy 
motion a fascination, it has positive demerits as used by the aver- 
age rider, and conies far from furnishing a model exercise. It 
calls into action the pedal extremities, and may develop esthetic 
calves, but leaves many organs of the body only poorly exercised. 
Few riders take the proper position for sitting or riding ; the head 
is lowered, the face turned up, the neck unnaturally bent, the 
shoulders and back humped,- the chest and abdomen drawn in, and 
the body bent at an acute angle at the thighs, pushing the pelvic 
organs out of place and throwing the weight upon the prostate 
or vulva. If the seat be too narrow, the soft hip bones of young 
girls are pressed together, the opposite condition from that pre- 
vailing when the weight of the body rests naturally upon the 
widely separated heads of the thigh bones. 

Bicycling violates a fundamental law of correct exercise — fair 



SANITATION. 41 

play to all organs — but, if the wheel be ridden, the body should 
be maintained in an erect position, while the saddle should be easy, 
firm and elastic, and permit pedaling without friction. Many 
saddles in common use are adapted to the male rider, but the small- 
est number recognize that the pelvic organs of the two sexes are 
not built after the same pattern. If the pommel is high it inter- 
feres with the dress of the lady rider; if too low, she slides forward 
and is uncomfortable ; if narrow, fleshy women chafe ; if broad, 
those who are thin complain. A saddle perfectly adapted to the 
female rider has not yet been constructed. 

Among the good things for which the bicycle stands, is an- 
other evil which must not be overlooked. Everyone, when first 
riding the wheel, finds it prone to fall upon one side or the other, 
and that constant watchfulness and effort are necessary to keep 
it in balance, and an old rider, in rapid motion, more than the 
locomotive engineer, needs a watchful eye, for his track is often 
full of obstructions. As the rider gains mastery of his machine, 
the effort to keep it in balance seemingly disappears, but the rapid 
movement, at full speed, is so fraught with peril as to demand con- 
stant attention and will-force, which, when long continued, bring 
the anxious expression, always a danger signal, seen in the face of 
the professional cyclist. Although the bicycle is beneficial to 
those who use it for short periods only, in proper position and 
at moderate speed, and although it ministers to the American 
habit of haste, it is not as healthful to the sedentary as a walk to 
and from the office. 

Cycling in any but the best way involves loss of pleasure and 
profit, and may cause both functional and organic injuries. We 
tell the beginner to sit up straight, and he assumes a perfectly 
erect position, perhaps bringing the coccyx in painful contact with 
an improperly constructed saddle so that the spinal column suffers 
injurious jars, and making progress wholly dependent upon the 
muscular action of the legs. The would-be professional bends 
the body at a very acute angle at the hips, draws in the chest and 
abdomen and humps the shoulders, compressing the vital organs 
of the chest and pressing the contents of the abdominal cavity into 
the pelvis. This position is full of danger to every rider who 
assumes it, and especially perilous to women and girls. It is void 
of art and science, prevents continued action, injures health, and 
is far from being esthetic. 



42 



SANITATION. 



The following excellent suggestions on the saddle, by Theo. 

R. MacClure, were brought out at a recent sanitary convention 

in Detroit: 

"The bicycle seat should have the same relation to the rider as 

does the properly constructed chair; it should be flat, rigid and 

fixed in its shape, and at no time 
should any portion of the seat 
cause undue pressure upon parts 
in one of the most delicate re- 
gions of the human economy. 
To better place this portion of 
the subject before the reader, we 
have, in connection herewith, 
three illustrations — Figs. I, 2 
and 3. 

"Fig. 1 represents the bony 
pelvis of the human being. The 
two prominences marked 'A' are 
the ischial tuberosities upon 
which the weight of the body 
when riding a wheel should rest. 
'B' exhibits the pubic arch, 
which protects a portion of the 
anatomy upon which the weight 
of the body should never rest, for 
any considerable time. The 

pubic arch is nature's protection 
for some of the more delicate and 
sensitive parts, among which are 
the prostate gland, the bulb, ure- 
thra, etc. Any condition which 
shall interfere with nature's ar- 
rangement will throw down the 
bars of protection, and sooner or 
later result in permanent and se- 
rious injury. The insidious way 
in which these injuries gain a 
foothold misleads the one be- 
ing injured ; and, while there may 
be premonitory symptoms or 




SANITATION. 43 

warnings, they are not such as to be observed until too late, when 
the injury has occurred. 

"Fig. 2 represents the bony pelvis seated upon the common 
hammock saddle, the saddle against which we should guard. 
It will be seen that the weight of the body ceases to be supported 
by the ischial tuberosities, but is supported by that portion of the 
body called the perineum. 

"Fig. 3 exhibits the bony pelvis resting upon a flat rigid 
seat, the weight of the body falling upon the two bony prominences 
of the pelvis. The seat represented in this plate consists of two 
separate pads or cushions, between which is a groove or depres- 
sion, about one inch across, for the better protection of the peri- 
neum from pressure. Any bicycle seat made upon the plan ex- 
hibited in this plate will be less likely to cause injury to the delicate 
portions of the body situated in the region of the perineum. The 
horn should be free from sharp corners, and padded or cushioned 
when practicable. 

"The pelvic bones vary, so that in some, especially in females, 
the tuberosities are closer together than in others. The seat 
should be wide enough to permit these bony prominences to 
rest comfortably upon the pads. It is equally important that the 
seat be not too wide, in order that the pedaling can be ac- 
complished without unnecessary friction or chafing by the edges 
of the seat." 

When the saddle is too far back or too low there is loss 
of power, while the unduly bent knees become painful, the ankles 
lack freedom of action, the shoulders are humped, and progress up 
hill is barred. Fat persons prefer the low saddle because it 
facilitates mounting and dismounting, but the position is neither 
graceful nor healthful. The other extreme must also be avoided. 
When the toe just reaches the pedal, it involves an injurious and 
awkward twist of the back and sides, and a loss of power, es- 
pecially on up-grades. The saddle should be well over the pedal 
and its height will be right for a person sitting upon it when he can 
place his foot under the pedal, the pedal resting upon the instep. 
Persons of different heights should not use the same adjustment. 
It is important that the seat be neither too hard nor too soft. 
W hen the body rests properly upon it the weight will be supported 
squarely upon the pelvic bones, with trunk at right angles to the 
tilt of the saddle. ' If the handle bar is too high there is an un- 



44 SANITATION. 

comfortable and unseemly bend of the elbows, and the position is 

unsteady. 

LEFT-HANDED PEOPLE. 

There is another subject that has not been sufficiently dwelt 
upon by those who have discussed exercise. The Creator does no 
unnecessary thing, and the work of the hygienist, and the true 
physician, is to see the work of the great Architect well done 
rather than to make substitutions. In all vertebrate animals the 
nerves and muscles are usually in pairs. Man is no exception to 
the rule. Children are born with both sides equal in form and 
function. Heredity may in some instances make a difference, but 
that is the rule. They are also born weak and helpless and almost 
wholly void of instinct. From the cradle to the grave all the 
faculties are developed by education. Nature yields to the teacher, 
and the babe is hardly born before its education commences. 

When or why man became right sided is not within the 
scope of our discussion, but the exceptions are too numerous to 
prove it a physiological law. Most persons are dexterous, right 
handed ; but whole tribes have been ambidextrous, left handed. 
In the earliest history of the race, Moses tells us the tribe of Benja- 
min was left handed, and adds : "They were mighty men of war." 
From the fact that, in certain vocations, men use either hand with 
equal facility and the more important fact, that man is born with 
his nerves and muscles equally paired, we conclude the Creator 
designed that man should use with equal convenience the right 
and the left hand, and that the employment of either alone is a 
human innovation, but no improvement on the divine plan. 

Ninety per cent of the peripheral nerves cross each other as 
they pass to the nerve centers in the brain. As already stated, 
the properly directed exercise of an organ develops both its form 
and function. The nerves are developed, not only in the acting 
muscles, but in the nerve trunks and centers as well. When the 
right muscles are alone or largely used, the right brain is propor- 
tionately functionless, while in the left are stored the results of our 
actions, perceptions, and memories, and here the will is chiefly 
functioned. 

We are not surprised to know that in such diseases as aphasia 
(loss of word memory), there is usually softening in that portion 
of the left brain where the record of words is kept, the third left 
frontal convolution. The exceptions to this rule are among the 



SANITATION. 45 

left handed, and this theory of right handedness is confirmed by 
such cases as that of Prof. Lourdet of Montpelier, France, who, 
having lost both the power of speech and the use of the pen, taught 
himself the use of the left hand, and, letter by letter, and word by 
word, learned again to write and speak. 

By exercising both sides of the brain, as by the use of both 
eyes, they are enabled to give to each other mutual assistance and 
rest, and when, from injury or disease, one loses its function the 
other may take up its work, but when either right or left sidedness 
alone is developed one hemisphere of the brain is held in abeyance, 
or dwarfed, and there can be no exchange. The health and de- 
velopment of the nerve centers and brain, the co-operation of the 
peripheral nerves and the development and strength of the mus- 
cles, in short, a full, harmonious and symmetrical development of 
all the organs of the body, is involved in the equal training of both 
its sides, and he who would possess complete control of all his 
organs and faculties must continue such use through life. 

THE ATHLETE. 

Man differs from other animals, only as he has a superadded 
spiritual life controlling his will and directing his forces. We have 
just begun to recognize the power of this will. By it man is able 
to effect changes in his physical development in a few short years, 
that require generations in the brute. By careful training, the 
wild horse has been changed into the fleet-footed Arabian, the 
massive Percheron and the tiny Shetland, but these results have 
•been the work of many generations, and are preserved only by the 
most careful breeding and continued judicious exercise. 

Sandow, the Prussian athlete, belonged to a family in nowise 
remarkable for its physique, but through localizing muscle-build- 
ing, and associating with his training voluntary control, he reached 
his most wonderful development at twenty-six years of age. At 
eighteen he was in every way beneath mediocrity. By exercising 
his various muscles as they required, though only five feet eight 
and one-half inches in height, he gained a measurement around the 
chest of 46 inches, about the waist 29, with an expansive mobility 
of 14 inches under the axilla, over the deltoid 17 inches, over 
the shoulder 21, over the biceps 19^, around the forearm 19, 
around the thigh 27, and around the calf ij\ inches. With ap- 
parent ease and one hand, at arm's length, he lifted from the floor 



46 SANITATION. 

straight over his head a hollow dumb-bell with a man in each 
globe, together weighing 305 pounds, and as easily let it down 
again. With his feet and hands upon the floor he supported 
three horses, weighing 2,800 pounds, upon a platform resting 
upon his chest and knees. Although through volitional control 
over his muscles he secured this wonderful muscular power, he did 
not develop spiritual life and control, and was far from being an 
intellectual giant. 

Seeking the development of the whole man we must remem- 
ber that the methods that develop the mere animal organs do not 
materially impress those through which the spirit acts. From 
Samson, shorn of his strength by the seductions of Delilah, down 
to the pugilists of the present day, neither athletes nor gymnasts 
have been distinguished for their mental or moral force. Many 
men with frail bodies, without "muscles," have gained as dis- 
tinguished conquests in the world of mind, as athletes without 
mind have won in the world of muscle. Aim at neither extreme, 
and remember that while a well balanced, healthy physical organ- 
ism is essential to life and intellectual growth, an excessive ani- 
mal development is a hindrance to both. 

If sudden death does not come to the athlete for taxing 
his heart beyond its strength, his abnormal muscles, to preserve 
their health, must be exercised in proportion to their development, 
and to sustain this the digestive organs must be overtaxed to feed 
them, the circulatory to carry to them their nutrients, the respira- 
tory to oxidize their blood, and the excretory to remove their 
waste. 

For him to stop this exercise is not less dangerous than to 
continue it. The removal of unused and devitalized tissues is 
always full of danger. Use his organs as he may, sooner or later 
he will reach the down-hill grade, when the involution of his 
massive muscles will invite disease. 

COLLEGE ATHLETICS. 

Just now a mania for muscular development is mani- 
fest in our colleges. The learned professors in some of 
our leading universities seem to have forgotten that while 
muscular efforts demand increased activity and development 
of all the merely physical organs, the athlete does 
not gain either intellectual or moral force from punch- 



SANITATION. 47 

ing bags, or kicking balls, and that a student with mind in- 
tent on football, or anything else foreign to mental training, and 
who frequently interrupts his college course to give exciting ex- 
hibitions of his muscular powers, is not pursuing the best educa- 
tional methods and results. 

The development of man is in line with his activities. While 
the health of all the organs of the body should be preserved 
through regular and moderate use, we think the college should 
chiefly be a gymnasium for mental training for beneficent pur- 
poses. It should not be dedicated to the forcing of the organs 
of mere animalism. During student life, violent sports are in- 
jurious rather than beneficial, and the college contests at football, 
as described by the press, are in every way demoralizing and differ 
from the ring onlv in the character of the actors. Brutality pre- 
dominates in both. We are aware that its friends claim that it 
develops courage, determination, will-force, self-restraint, quick- 
ness of perception and decision. The same is claimed for the ring. 
Purpose, determination and decision may be bad as well as good. 
Surely the fruits of the ring are not the highest exponents of 
civilization, and may we not expect like results from a game where 
a half score of players fight with hands and feet, breaking noses, 
ribs and limbs, dislocating joints, slugging on the sly, and, in some 
instances, taking life? 

Exercise is essential to physical health, but we should under- 
stand its laws, and develop those faculties which distinguish man 
from the brute. Cultivating the merely animal organism does not 
develop the cells through which the spirit acts, and much time 
and thought given to exciting sports during a college course are 
worse than lost. We reap what we sow. Physical exercise in 
some form is indispensable to health and longevity, and these, in 
the educated, are of incalculable value both to the individual and to 
the state, but, develop as he may, man cannot make his physical 
strength equal that of the ox, and he should not attempt it. 
God created him for other and nobler purposes. His mental and 
moral faculties should have precedence. His perfect development 
does not mean transformation into a behemoth, but the symmetry 
which secures the perfect health of all his organs, makes his body 
a fit instrument for the mentality which, laying hold of unseen 
forces, compels them to drive his engines over land and sea, and 



48 SANITATION. 

perfects those still higher activities by which he reaches out and 
up to the infinite. 

God alone creates, but to man is given recreative power, en- 
abling him to utilize the varied creations, and, in so doing, to 
become refined, noble and strong in mental and spiritual action. 
Of all his capacities, our chief interest is in his will, reason, affec- 
tions, character. We secure health and the power of endurance 
to the physical organism that it may be a fit instrument for the 
activities of the spirit and subject to their control. Man is made 
in the image of God, not physically but spiritually, and should seek 
such physical culture as will secure a sound body, but, at the same 
time, conduce to highest spiritual power. 



CHAPTER III. 

GERM-LIFE AND ITS RELATION TO DISEASE, AS UN- 
DERSTOOD BY THE BACTERIOLOGIST. 

In all the past, contagious and infectious diseases have been 
the world's most dreadful scourges, so resistless in their sweep 
and deadly in results as to be generally regarded as vengeful work 
of offended spirits, or inscrutable dispensations of Providence. But 
their mysterious power has gone, for having learned their secrets 
we are able now to combat and overcome them. Of all the 
discoveries of the present age, none is more wonderful or of more 
priceless worth than that of the germ causation of disease. 
It has dispelled the terrors ol the plague, stayed the pestilence 
and added to the years of human life. No class of diseases now 
yields more readiiy to preventive measures than the contagious 
ones; while nearly all the infections have been found amenable to 
simple laws, and the remaining few are likely to soon be added to 
the list. 

In this revolution the bacteriologist has suddenly become the 
great benefactor, worthless theories have given place to exact 
science, and in the medical world nearly all things have become 
new. It has been fully demonstrated to the satisfaction of the 
most critical that the causes of these diseases are micro-organisms 
known as bacteria; that of the very numerous varieties of micro- 
scopic life only a few are pathogenic, or disease producing, and 
that these in almost every case are taken into the system with the 
breath, food or drinking water. Hence, air, food and water, as 
the media of infection, possess an interest never accredited them 
before, and how to get them pure and keep them so has become the 
main problem of sanitary science — "the science of how to keep 
well." 

The infections or germs which float in the air and are carried 
into the system with the breath are called air-borne ; and the dis- 
eases thus disseminated are air-borne diseases. Consumption, 
pneumonia, diphtheria, whooping-cough, scarlet fever, yellow fever, 
3 49 



50 SANITATION. 

measles, mumps and influenza belong to this class. It will be 
noticed that most of them manifest themselves chiefly in ailments 
of the throat and lungs. 

"As the air is breathed by everybody in the same inclosure, the 
only safety lies in isolation of the patient, and prevention, as far as 
possible, of the spread of germs into the common atmosphere. 
The air-borne germs are not always expelled from the diseased 
person in his breath, but may escape through the skin, and, in 
throat and lung diseases, are found in myriads in the sputum. 
If this be allowed to dry in the open air, the germs will be taken 
up as dust, and some of them will reach the throats and lungs of 
other people and be implanted there. This is the common method 
by which consumption, pneumonia and diphtheria are dissem- 
inated, and it is even more for this reason than to avoid the dis- 
gusting filth that ordinances are made forbidding spitting in cars 
and many other public places. Indeed, the dust from dried expec- 
torations in cars, hotels, stores, factories. schools, assembly halls, etc., 
is a constant source of danger, and suppression of the filthy habit 
of indiscriminate spitting would be a most important step toward 
public safety. 

"When fully developed, pulmonary consumption is still gen- 
erally regarded as an incurable disease, but it is no longer con- 
sidered hereditary. One may inherit a physical weakness, a pecu- 
liarity of cell, which predisposes to the attacks of its microbe, the 
bacillus of tuberculosis, but weakness alone cannot bring the dis- 
ease. The specific seeds must be planted, and these must come 
from another diseased person or animal, and may enter the system 
in the food as well as with the breath, for cattle are frequently 
afflicted with this disease, the microbes of which may be found 
in their flesh, and, in extreme cases, in their milk.'' 

Typhoid fever, malarial fever, cholera and some of the 
diarrheas are usually water-borne, but as they may be disseminated 
by any means through which their germs can reach the stomach, 
food as well as water may be a medium of infection. It is, there- 
fore, of the highest importance that both food and water be clean. 
By cleanliness, in this connection, is meant freedom from disease- 
producing germs. It is not enough that water should seem pure, 
for though pleasing to the taste, and clear and sparkling, it may 
abound with death -producing germs. 



SANITATION. 51 

NECESSARY PRECAUTIONS. 

Although freezing appears to have very little influence upon 
many of these germs, they are extremely sensitive to heat, few sur- 
viving 158 degrees in streaming steam and none of them being able 
to long withstand the temperature of boiling water. Hence, by 
thoroughly cooking food, and carefully keeping it from contami- 
nation thereafter, and by boiling all water used for drinking and 
culinary purposes, and carefully cleansing with water thus ster- 
ilized all fruits and vegetables to be eaten raw, the danger of con- 
tracting any of these diseases may be very largely overcome. But 
there are other points of attack which should also receive careful 
attention. Such pets as cats and dogs often carry infection, 
and, therefore, may be dangerous to children or others fondling 
them. Rats and mice, and, still more often, common house flies 
may become common carriers of these disease germs, hence, if for 
no other reason, every precaution should be used to prevent them 
from reaching human food. 

Xot only are careful personal habits essential to safety, but the 
amount of general infection should be reduced as much as 
possible everywhere. To this end individual and municipal efforts 
should be united in intelligent and unceasing warfare against all 
kinds of filth and accumulations of decaying organic matter for 
masses of putrefaction are ideal breeding places of disease-germs — 
fountains of infection, contaminating both air and water with 
subtle poisons causing misery and death. For the effectual treat- 
ment of these menaces to health see the department of "Disin- 
fection and Disinfectants. " 



CHAPTER IV. 



AIR. 



We may live for a time without food or drink, but no one can 
live without air. Tfre supply is ample, for it surrounds the whole 
earth, penetrates every crevice and extends above the highest 
mountain tops, no one knows how far. but to an estimated height 
of from 50 to 200 miles. Not only this, but provision is made for 
its constant renewal and purification. Pure air is commonly said 
to be one-fifth oxygen and four-fifths nitrogen, but absolutely pure 
air is never found. It may be considered pure when composed as 
follows : 

Oxygen 20 . 6.1 volumes ^| 

Nitrogen -77-95 I In one hundred volumes 



Carbonic acid gas. . .04 
Aqueous vapor .... 1 . 40 



of air. 



It will also contain traces of ammonia, nitric acid and car- 
bureted hydrogen and, if in a city, traces of sulphureted hydro- 
gen and sulphurous acid gas. While all the gases of the atmos- 
phere differ in weight, by the law of diffusion they are never at 
rest, and so intermingle that their proportion is maintained with 
great regularity at all temperatures and altitudes. 

Whatever other functions nitrogen may have, it is a necessary 
diluent of oxygen. When free or uncombined it is, as far as we 
know, negative in character. Variously combined it is an im- 
portant element in the tissues of both animals and vegetables. Its 
proportion in the air is not disturbed by the presence of carbon 
dioxide or other deleterious gases. They are present at the ex- 
pense of the oxygen and, when in excess, they are dangerous both 
on account of their own action and by their displacement of 
necessary oxygen. Any considerable quantity of carbon dioxide 
is injurious, but the atmosphere may contain four parts in 10,000 
without appreciable influence upon health, and even in much 
larger quantities it is a measure of injurious contaminations rather 
than dangerous itself. 

52 



SANITATION. 53 

Oxygen is the part essential to life. It is the most abundant 
element in nature, enters into all forms both of organic and inor- 
ganic matter, constitutes one-half the globe and, as we have already 
stated, one-fifth of the air surrounding it. It is a colorless gas, 
without taste or odor, and at ordinary temperatures is soluble in 
water to the extent of about two volumes in a hundred. It will 
not burn, but is the most powerful element of combustion. Apply 
a blazing match to the end of a tube filled with oxygen and you 
will obtain no results, but extinguish the flame and insert the in- 
candescent end of the match into the tube, and it will burst into 
a beautiful flame. It is by supporting combustion that it main- 
tains the heat of the body ; taken into the lungs it is carried by the 
blood to all the tissues and, by its contact with them, they are in 
part burned up — oxidized, the oxidation producing heat, force, 
and, as a residuum, carbon dioxide. This residuum is carried in 
the blood back to the lungs, and by them thrown out to become 
food for plants. Decomposed in plant cells, through the action of 
light, its carbon becomes fixed, as a part of organic matter, while 
the liberated oxygen escapes to be breathed again. Thus the 
animal provides food for the plant and the plant for the animal, 
a beautiful example of one of the many wonderful laws of equiva- 
lences found in God's handiwork. 

The contaminations of the air, also its density, humidity, tem- 
perature currents and electrical conditions, have a constant in- 
fluence upon health, imparting to seasons and localities many of 
their hygienic characteristics. 

The Density or weight of the atmosphere at any given point is 
affected by altitude, temperature and humidity. The rarified air 
of high altitudes produces various impressions upon physical life, 
causing labored breathing from the difficulty in securing sufficient 
oxygen, excessive heart action to force a larger quantity of blood 
to the lungs for oxidation, nausea, lowered temperature, convul- 
sive trembling and ocular fatigue, with a sense of languor and 
indifference. The diminished pressure upon the body often per- 
mits the exudation of blood through the delicate membranes of 
the eyes, nose and ears, and sometimes from the lungs. These 
conditions are increased by atmospheric movement, and are 
known as "mountain sickness." Properly selected altitudes, by 
swelling the capillary circulation of the surface, and correspond- 
ingly relieving the congestion in central organs, and by demanding 



54 SANITATION. 

full use of all the air cells of the lungs, may prevent the develop- 
ment of certain diseases or, if not too far advanced, may cure 
them. 

But in recommending altitude the sanitarian must consider 
the condition of all the organs of the body. Thus, however ad- 
vantageous to the lungs, rarefied air increases cardiac effort and is 
incompatible with various forms of heart disease. Altitude is but 
one factor of the climatic conditions essential to consumptives, 
for while, in the early stages of the disease, they need a rarefied at- 
mosphere, they also require dry air, the absence of sudden and 
extreme changes in temperature, and a climate that woos to 
exercise and' will enable them to spend much of their time out 
doors at all seasons. Man's adaptability to environment enables 
him to live in very high and very low altitudes, but idiosyncrasy 
should always be considered, and for those seeking health extreme 
changes must be gradual. 

Humidity. — Heat, by expanding or rarefying the air, makes 
it lighter than cold air, and, since the hydrogen in aqueous vapor is 
lighter than the oxygen and nitrogen it displaces, moist air is 
lighter than dry air, the specific gravity of air saturated with mois- 
ture being less than two-thirds of that of dry air, or, more exactly, 
as 623 is to 1,000. The warm, balmy air of coasts and sea-girt is- 
lands near equatorial regions is hygienic in many respects, but 
tends to enervate, and such localities are less favorable to the cure 
of consumption and allied diseases than warm, high and dry table- 
lands. Knowing that moist air encourages a tendency to con- 
sumption, those afflicted with lung diseases should go to the mesas 
of Arizona and New Mexico, where they will take full deep inspira- 
tions and enjoy outdoor life and exercise, rather than to Northern 
Colorado and Wyoming, where the rainfall is greater and the win- 
ters more or less inclement. Cold, damp air produces chilliness, 
contraction of the capillaries and engorgement of central organs, 
thus tending to congestions ; it also favors the development of 
rheumatism and the like, while warm, high and dry air relieves such 
conditions. Study to correctly interpret all the influences of the 
atmosphere upon health. 

Temperature. — In cities, and often in country homes, condi- 
tions popularly attributed to high temperature are really due to 
causes which are largely dependent upon accumulations of filth, 
bad drainage, poor ventilation, over-work, under -work, intemper- 



SANITATION. 55 

ance. improper diet, etc. Thus cholera infantum, tropical dysentery 
and yellow fever were long thought to be heat diseases, but are now 
positively known to be due each to a specific germ, which upon 
being taken into the system, especially if from violations of hygi- 
enic rules, or for any other reason, the subject is in a debilitated 
condition, multiplies with astonishing rapidity and develops the 
virulent poison that produces the disease. In moist accumulations 
of filth under high temperature these germs find excellent breeding 
places, until, through the medium of food, water or air, some of 
them can effect an entrance into the human body. Asiatic cholera 
and the Bubonic plague have been called heat diseases, but are due 
to germs which multiply and flourish in the unspeakable filth of 
the degraded worshipers of Juggernaut, and are dependent upon 
filth to keep them alive. So with other diseases attributed to 
heat ; high temperature is indeed a necessary accompaniment, but 
other factors, preventable in nearly every case, are essential to their 
development. Heat alone is very rarely a sufficient cause even 
for sunstroke, the debilitating influence of imperfect ventilation, 
vicious habits, faulty diet, over-work, etc., being a usual ac- 
companiment or prelude. 

Low as well as high temperatures have their characteristic 
diseases ; those of the air passages, as influenza, tonsilitis, croup, 
bronchitis and pneumonia, are some of them, especially when cold 
is associated with great humidity. They are largely favored 
by the abstraction of warmth and moisture. According to Dr. 
Baker of the Michigan State Board of Health, each cubic foot of 
air inhaled at zero contains only one-half grain of vapor, but when 
exhaled at 98 degrees is nearly saturated and contains about 18 J 
grains of water, having abstracted its additional heat and moisture 
from the air passages: Irritation, inflammation and suppuration 
are incident to such drains, and are always facilitated by the de- 
pressing influence of cold upon the nervous system, the part first 
affected depending largely upon the condition of the air passages. 
The lung substance is not usually involved until there has been 
long continued action. Hence, pneumonia does not generally 
prevail until February, March and April. Cold, dampness and 
density favor the development of pulmonary troubles, while the 
opposite conditions, found in a warm, dry, rarilied atmosphere, are 
preventives. 

Air Currents are important agencies in purifying the atmo- 



56 SANITATION. 

sphere, but are sometimes factors of disease. Warm, clamp cur- 
rents rising from the earth carry contaminating decompositions 
and infections, and currents passing over bodies of water become 
moisture laden, causing enervation by day and chill at night. 
Cold draughts, especially when charged with moisture, tend to 
rheumatism and neuralgia; and cold dry winds, as the northers 
of Texas and the bora of the Alps, are followed by inflammation 
of the air passages. Dry winds are filled with particles of matter, 
readily seen when passing through bright sun rays, and while we 
constantly inhale thousands of these tiny motes without harm, if 
composed of infectious or contagious matter they may cause most 
serious epidemics. 

Dusty country air is far less injurious than that taken up from 
the streets of villages and cities, laden with dried and pulverized 
droppings of cattle and horses, and sputa of consumptives and 
other invalids. What condemnation can be too severe for 
boards of health that permit butchers and grocers to make out- 
door displays of beef, mutton, fowls, vegetables and fruits, thus 
allowing them to become coated with such loathsome and danger- 
ous filth? 

Winds often carry disease. W T e have known typhoid fever 
to be borne by prevailing winds in a dry atmosphere from excre- 
mentitious matter of typhoid patients, thrown upon the ground, 
and to follow a track as clearly marked as when water-borne. 
Whether the germs were carried by the unaided breezes, or by flies 
whose flight was guided by the air currents, we do not know ; the 
result was the same, though, if by the latter agency, good screens 
might have barred the dangers from the home. 

Hot, dry winds, as the harmattan of the West African coast, 
are conducive to certain diseases, and the sirocco of Northern 
Africa and Southern Italy, whether dry or moist, has a depressing 
effect. So, too, the simoon of India and the hot winds of Australia 
are deleterious to both vegetable and animal life. • Even in their 
milder form, as sometimes found on our western plains, they sap 
human energy and may be injurious. 

In this latitude remittent fevers and diseases of the alimentary 
canal reach their acme during the heat of August, typhoid fever in 
September and October, diphtheria and croup in November, De- 
cember and January, acute lung diseases in late winter and early 
spring, and consumption, well nigh perennial, reaches its climax in 
March. 



SANITATION. 57 

Sudden changes tend to disease, but the human organism so 
readily adapts itself to new conditions as to soon become ac- 
climated. While the sanitarian recognizes the influence of seasons 
and climates in the production of diseases, he attributes them more 
to other causes, of which the chief are infection, ignorance and 
neglect. 

Carbureted Hydrogen. — In mines a carbureted hydrogen 
often accumulates which, though not serious to health, is danger- 
ously explosive when mixed with air. Carbon dioxide is one of 
the products of such explosions, and is what is known as after- 
damp. It may also be present without an explosion, in such 
quantities as to asphyxiate as completely as though drowned in 
water, those exposed to its action. It is frequently found in pits 
and wells. Xo one should enter such places, if they have been 
long unvisited, without first letting down a lighted lamp or candle. 
If it be extinguished, gas is there, and must be removed by heat 
or some other means. As good a way as any is to slack lime in the 
pit or well, for the process creates a current by the generated heat, 
and the slacking lime absorbs gas, so that a double action is ob- 
tained. 

Being heavier than air it may also be drawn out by a cord 
fastened to an inverted umbrella, much the same as drawing water 
with a bucket, repeating the process until on letting down a candle 
it continues to burn. 

Carbon Monoxide is one of the most common and most dan- 
gerous gases with which we have to deal. It is the gas which 
escapes from stoves when their draught is defective, or when they 
are sufficiently heated to open the pores of the iron. It causes 
many deaths from the ignorant blowing out of gas lights, instead 
of properly turning off of the gas. Turning down gas to produce 
only a slight light is always dangerous, for a sudden draught may 
blow out the flame, and the gas will continue to escape. This 
gas often poisons the air about coke and charcoal ovens, smelting 
and gas-works, producing in the Avorkmen general debility, and 
diseases of the respiratory organs. The poisoning from it causes 
headache, dizziness, roaring in the ears, weakness, vomiting, un- 
consciousness, convulsions, diminished heart and lung action, and 
complete asphyxia. At all works where injurious gases are 
generated every precaution should be taken to supply good air 
to the workmen. 



58 SANITATION. 

Sewer Gas is a mixture of gases, vapors and solid particles, 
derived chiefly from organic matter in a state of decomposition. 
Carbon dioxide, sulphureted hydrogen, ammonia, etc., are usually 
present. The great danger lies in the germs which produce the 
decomposition of the particles of animal and vegetable matter. 
That sewer gas is itself capable of producing such diseases as 
scarlet, yellow, typhoid and malarial fevers, cholera, etc., is no 
longer believed, but gas from sewers containing excreta from pa- 
tients laboring under these diseases, if connected with houses by 
improper plumbing, or defective traps, may contaminate food or 
water left near sinks or other openings, especially if, from disuse 
for a few days or weeks in hot weather, the pipes and accumulated 
matter within them become dry, in which case it may also be 
possible for germs to settle upon the lips of one breathing the gas 
and be carried in the saliva to the throat or digestive tract, the 
fields for their deadly work. It is certain, however, that gases 
as poisonous as those that escape from sewers will, if long inhaled, 
reduce the system to a susceptible condition for the easy con- 
traction of these diseases, and it is probably in this way that most 
of the mischief is done. Wash basins and other conveniences with 
sewer connections should never be in living or sleeping rooms, 
no matter how perfect the plumbing. They are likely to be bad 
enough in the kitchen and bath room where they can be shut 
from the rest of the house and their dangers reduced by special 
ventilation. 

Dust containing organic matter, not septic, often produces 
serious results. Workmen in tobacco factories usually suffer for a 
fortnight after commencing work, from catarrh, nausea, nervous 
troubles and loss of appetite. In pregnant women there is a 
tendency to abortion. The system soon accustoms itself to the 
action of the poison, though it often leaves a permanent impress 
upon the nerves, and an irregular action of the heart and lungs. 
The average life of the cigar maker is but 38 years. Millers, 
though often hearty and seemingly robust, frequently suffer from 
pulmonary diseases, and have an average life of but 46 years. 
Those operating grain elevators and threshing machines suffer 
from a very irritating dust which loads the pulmonary mucous 
membrane, often producing severe rigors after the first day's 
work ; but in a short time the system becomes accustomed to it 
and suffers less. 



SANITATION. 59 

We have known one season's work to destroy the lives of 
all those who spent much of their time in a dust saturated room, 
engaged in the manufacture of ochre brick by the dry process. 
Brush makers, from the inhalation of sharp fragments of bristles, 
are prone to lung diseases. Cotton-mill operatives, from breathing- 
air iaden with cotton liber, suffer from various forms of bronchial 
and pulmonary trouble, frequently ending in consumption ; while, 
because of the oil in wool, consumption among woolen-mill opera- 
tives is comparatively rare. Wool and rag sorters' disease is prob- 
ably a form of anthrax, due to specific contamination, and its pre- 
vention lies in properly steaming the stock before giving it to the 
pickers. The lungs are stained by coal dust, just as the skin is 
stained when long kept in its solution. The lung tissues of an 
old coal miner are a bluish black, though the occupation rarely 
tends to pulmonary disease. 

Inorganic Dusts often produce grave results. Among file 

cutters, 62.2 per cent contract phthisis ; needle polishers, 69.6 per 

cent; grinders, 40.4 per cent, with an average life of 30.16 years. 

In grinding glass, cutting millstones, or any other occupation 

that fills the air with dust, there always is a tendency to serious 

lung disease, the danger being in proportion to the sharpness of 

the dust, and the quickness of its chemical action. Prevention 

lies in guarding against the admission of the dust to the air 

passages. 

VENTILATION. 

By ventilation we mean change of air by artificial methods, 
whereby that which is pure is made to displace that which has be 1 
come impure. It is essential to the health of all who live in en- 
closed spaces, and is of special importance in homes continuously 
occupied. It is perfect when pure air, at an agreeable temperature 
with proper moisture, is distributed throughout an enclosure with- 
out perceptible draught, in such quantity as to prevent its occu- 
pants from inhaling that which has been exhaled or otherwise con- 
taminated. Y\ nen taken into the lungs, air iswarmed, moistenedand 
made lighter, so that when exhaled it rises, creates a current and 
gives place to fresh air. In this way nature provides that we shall 
be ventilated, and never permitted to breathe air which we have ex- 
pired, if opportunity be given it to escape, but man, in his un- 
wisdom, to economize fuel has applied every mechanic art to make 
the house tight, thus keeping in exhausted and contaminated air, 
and keeping out that which is pure and invigorating. 



60 SANITATION. 

As the average adult breathes 540 cubic inches of air every 
minute, and in the same time throws out about 25 cubic inches of 
carbon dioxide which pollutes and makes unfit for breathing 5>°°° 
times its volume of air, one can readily understand the importance 
of ventilation. To breathe an atmosphere from which the oxygen 
has been exhausted is to starve in the midst of plenty, while to 
breathe contaminated air is suicidal. When, upon entering an oc- 
cupied room, a musty odor is noticed, and there is a sensation of 
faintness, you may feel sure that it contains a much larger pro- 
portion of carbon dioxide than the air without. Dr. Parks says: 
"Impurities may be detected in this way when there are 6 parts of 
carbon dioxide in 10,000, and when there are 10 parts the air is 
markedly close and unpleasant to those coming from a pure 
atmosphere." 

Sanitarians generally agree that the standard of purity shall 
be about two parts of carbon dioxide in excess of that contained 
in what is called pure air, which we have already seen is about 
•four parts in 10,000. Not only is the dioxide itself injurious, but, 
when due to respiration, is a danger signal because of the poison- 
ous effete matter always associated with it. Ventilation must pre- 
vent it from being present in larger quantity than six or seven parts 
in 10,000. It may be detected by moistening a piece of blotting 
paper with aqua ammonia and placing it within a cylinder of the 
same paper moistened with dilute muriatic acid. If present in 
dangerous quantity there will be the white fumes of muriate of am- 
monia. The test should be made in the stratum that is being 
breathed and at the places of entrance and exit. If the above 
standard be accepted as the limit of impurity, about 750 cubic feet 
of air per hour must be distributed to each occupant of a room. 

We should always consider the source from which air is re- 
ceived and guard against the admission of that already impure. 
Ground air and air contaminated by any kind of sewage or dust 
must be carefully avoided. The best air for ventilating purposes, 
especially in cities, is that taken from above contaminating in- 
fluences, admitted through a shaft and forced downward by some 
fanning process. All buildings occupied by many people should 
be ventilated in this way. By using ice in hot weather, buildings 
thus equipped may be kept comfortably cool. In planning for 
ventilation we must consider the cubic space of the apartment, the 
number of inmates, how long they will occupy it, the rapidity with 



SANITATION. 61 

which the air may be changed without dangerous draft, and the 
mode of heating and lighting. A room 25x30 feet, with a ceiling 
of 13^ feet, will contain 10,000 cubic feet. If occupied by 40 
persons each would have an air space of 250 cubic feet but, if oc- 
cupied continously, each should have from 300 to 400 feet. 

A school room, well ventilated and frequently flushed, occu- 
pied from six to eight hours daily, will be healthful with 240 cubic 
feet to each pupil. The average school room does not give half 
that. If the over-crowded apartment does not stupefy the brain 
of both pupil and teacher, and develop actual disease, it will devital- 
ize until its occupants become easy victims to every type of dis- 
ease, especially the septic ones ; as scarlet fever, typhoid fever, diph- 
theria, measles, etc., the great destroyers of childhood and youth. 
Very great care should be taken in the ventilation of all rooms 
continuously occupied by many people, and this is especially 
true of the school room. Large numbers of children are often 
crowded into apartments entirely too small and their little lives 
jeopardized by teachers not well informed on ventilation and the 
dangers arising from breathing poisonous air. 

To ventilate with cold air the entrance and exit should both be 
near the ceiling but on opposite sides of the room, that the pure, 
cold, heavy air descending may displace that which has become 
impure, warm and light, by crowding it through the exit. Xo 
one should sit under such an entrance, for a current of cold air 
falling upon the head is dangerous. This may be largely avoided 
by such an arrangement of slats as will give the current an up- 
ward turn. Dust may be kept out by stretching thin flannel over 
the openings. There should always be a current passing through 
the room. 

Where windows must be used for ventilating and a large 
amount of air is not required, a good way. is to fit a board, five or 
six inches in width and as long as the window is wide, to the under 
side of the lower sash so as to permit no air to pass under the win- 
dow when raised but to admit a nice stream, with an upward turn, 
between the lower and upper sashes. Two or more windows on 
opposite sides, thus equipped, will do much toward keeping the 
air of an ordinary room pure and healthful. 

Good ventilating shafts for houses to be warmed by stoves 
may be cheaply obtained by building the chimneys large, say 18 
inches square inside, then running the stove-pipes up inside them 



62 SANITATION. 

to their tops, but a better plan is to build a separate ventilating 
shaft close beside the smoke flue. In either arrangement two 
registers, one near the floor, the other near the ceiling, should open 
into the ventilating shaft from each room. 

The heat from the stoves will create strong drafts in the 
shafts which will draw from the rooms opening into them. Open 
fireplaces or grates are excellent ventilators. 

Air must be admitted from a pure source. Cellar air, so 
commonly supplied to furnaces, is always dangerous. Pathogenic 
germs rarely rise above the lower strata, hence air taken from 
above the roof is usually the most desirable. When this cannot 
be admitted, the opening to the shaft should be as far above the 
ground as practicable and, when heated, should not be carried into 
the rooms through the floor, where the registers are liable to be- 
come clogged and fouled by sweepings and other contaminations, 
but through walls near the floor, and discharged near the same 
level on the opposite sides. That it may be equally diffused 
throughout the room, without perceptible draft, it is better to 
have several points of entrance and exit. Unpleasant drafts may 
be corrected also by making the entrances larger than the exit but, 
in every form of ventilation, let it always be remembered that 
ample provision must be made for the removal of foul air. 

The proper size for flues and registers can be found by divid- 
ing the number of cubic feet of air to be supplied per second by 
the velocity in feet, per second, of the air at the inlet. It is better 
to have the openings, both inlets and outlets, made too large, rather 
than too small, as their size can be more readily reduced than en- 
larged. The velocity should never exceed six feet per second, and 
if the registers are so placed that the admitted air strikes the occu- 
pants it should not exceed one and a half feet. The amount of 
air to be supplied w r ill depend more upon the number of persons 
than upon the number of cubic feet the room contains, but a room 
warmed by hot air and equipped with proper exits will require 
more to keep it comfortable than is needed for respiration. The 
current may be stronger at the outlet than at the inlet without 
causing dangerous draft. If the shaft be built next to a warm 
chimney, the velocity will be increased. 

Some novel modes of ventilation have been patented, which 
are even worse than the economy of corking every crack and 
crevice by which pure air may enter and foul air escape. Where 



SAX IT ATI ON. 63 

builders, especially school boards, are not thoroughly posted in 
scientific ventilation they should consult a disinterested expert, for 
no feature of the building is more important. 

"Dry water closets" are rarely, if ever, satisfactory and should 
never be placed in either public or private houses. Sewage should 
never be permitted to accumulate in or about a building, and if 
dried or cremated it must be done where it cannot contaminate the 
air breathed by people, and every precaution should be used to 
prevent sewer gas and other noxious air from entering ventilating 
shafts, except as drawn from the rooms they ventilate. 

Where there are no arrangements for improved methods of 
heating and ventilation, an equal diffusion of warmth and pure 
air may be secured by surrounding the stove with zinc sheeting, 
open at the top, with an air space of a foot between it and the 
stove. Pure air from outside the building must be admitted 
through a pipe terminating beneath the stove and after being dif- 
fused through the room, escape near the floor at the several sides 
into ventilating shafts. 

In every school room, and in all rooms occupied for many 
hours by many people, there should be a few simple instruments. 
A thermometer should be placed four feet above the floor, and 
should register 68 degrees Fahrenheit. To know that warmth 
is equally diffused it should, from time to time, be placed in dif- 
ferent parts of the room. An air tester, indicating the purity of 
the air, is even more important. Wolpert's is a good one and 
easily comprehended. A hygrometer, showing the percentage of 
moisture, is also useful. Danville's, Regnault's and Heddlestom's 
are all good instruments. 

The greater the amount of air, whether warmed before or 
after its admission, the greater the amount of fuel required. Ven- 
tilation and heating are interdependent. It is false economy to 
sacrifice the former to the latter, for, although there can be no 
cheap system, a perfect system is always worth more than it costs. 
If we can secure in the home and other buildings occupied by 
human beings an abundant use of pure air, we shall have done more 
toward preserving health and prolonging life than we could by 
the solution of any other sanitary problem. The lowered vitality, 
consequent upon imperfect ventilation, may be gradual, at first 
inappreciable, but it undermines the health, lessens the power to 
resist infectious and contagious diseases, and tends to premature 



64 SANITATION. 

age and death. Its influence upon some may for a time be un- 
perceived. The power of adaptation to environment, always 
great, varies greatly in different individuals, so that it is ever the 
old story : "And two women shall be grinding at the mill, the one 
shall be taken and the other left." 

The causes of disease, physical as well as mental, rarely occur 
singly, and it may sometimes be difficult to say which is responsi- 
ble, this or that. Scientific sanitation seeks not only to know all 
the causes of disease, but to remove them all, a consummation that 
never can be reached without the aid of ventilation and a con- 
stant and liberal supply of pure air. 



CHAPTER V. 



WATER. 



We can live longer without water than without air. but as 
the body is from four to five sevenths water, from which, by excre- 
tion and exhalation, there is constant loss, a frequent renewal of 
the supply is essential to life. Water is the medium by which the 
nutrients and waste products of the body are held in solution or 
suspension, and borne to and from the various tissues and organs, 
and the diseases consequent upon an inadequate supply of it cover 
the entire list of those caused by innutrition and the non-removal 
of the waste incident to all activity. Nothing can atone .for in- 
sufficient water. 

It is very important that water for domestic purposes be pure. 
All organic matter, undergoing or liable to undergo decomposi- 
tion, renders water impure, and although it may contain no spe- 
cific form of sepsis producing cholera, yellow fever, typhoid fever, 
or the like, it gradually lowers vitality and systemic resistance, 
thus tending to the ready inception of all forms of disease. Some 
minerals in moderate amount are inert, or even healthful, while 
others in the smallest quantity are poisons. Absolutely pure 
water, H2O, does not exist in nature. Lake Loka in Sweden 
is said to furnish the nearest approximation, and to contain but 
one twenty-eighth of a grain of solid matter per gallon. Decom- 
posing algea and other water plants, and the leaves of most trees, 
are less dangerous than decaying animal matter, which is less 
dangerous than ordinary human excreta, and very much less dan- 
gerous than the discharges from patients laboring under certain 
diseases. 

In all cities most homes are, and should be, provided with 
hydrant water, the purity of which is likely to be measured in 
each case by the degree of civilization possessed by the city, that 
civilization being highest which furnishes the purest and most 
abundant water. In densely peopled localities no wells should 
be tolerated, for in cities and most villages, old or recent privy 
pits and cesspools honeycomb the ground, while leaking sewers 
5 65 



66 SANITATION. 

and made soil are common, furnishing constant contamination 
and, often, a terrible death rate. 

Country wells, properly made, are usually healthy, though 
we have seen fearful epidemics of typhoid fever and diphtheria in 
rural homes caused by wells being contaminated by privy pits 
and other foulness. It is a rule that the privy should be one 
hundred feet from the well. This is the minimum. When the 
soil is porous or the dip of the strata is from the privy toward 
the well, the distance should be very much greater. Always 
avoid the latter arrangement, if possible, by placing the privy on 
the lowest ground. Specific poisons, such as produce typhoid 
fever, yellow fever, Asiatic cholera, malignant dysentery, etc., in 
the smallest possible quantities, are dangerous, and all danger 
signals should be regarded. 

The greed of gain characterizing too many water companies 
should not be allowed to hazard the lives of their patrons. The 
water supplies of cities taken from streams receiving city sewage, 
and distributed without proper sedimentation and filtration, may 
be condemned without analysis; and so may wells, although their 
water be clear and sparkling, pleasing to the palate and compara- 
tively free from organic matter, if they be in the neighborhood 
of privy pits, or allied sources of pollution, especially if any water- 
borne disease has followed their use. Taste and appearances may 
be very unreliable guides. 

SEDIMENTATION. 

Sedimentation means permitting water to stand in basins 
until its heavy inorganic matter falls to the bottom, carrying with 
it a portion of the organic contents, while the remainder are more 
or less perfectly disintegrated by the action of microbes. The 
agency most relied upon for purifying water is filtration, but sup- 
plies containing much solid matter in suspension must first be 
treated by sedimentation. In this process, properly conducted, 
the water is drawn from one basin to another until it is clear, the 
number and size of the basins being regulated by the impurity 
of the water and the amount required. An acre in extent is a 
convenient size. The basins at St. Louis emphasize their im- 
portance. They each hold 18,000,000 gallons of water, and the 
sediment, removed every four months, amounts to 2,000,000 cubic 
yards per annum. To all water containing large quantities of 
finely powdered soil, a week should be given for sedimentation. 



SANITATION. 67 

FILTRATION. 

Filtration is the passage of water through some substance 
that removes from it the solid particles. The bacteriologist con- 
tends that, to be of any value, filtration must also deprive it of its 
bacteria. Pursuant to this the following points were so clearly 
made by Prof. J. B. Johnson, of Washington University, in an 
address before a recent meeting held by our State Board of 
Health, that we quote by permission : 

"In general, there are but two sources of water for domestic 
use — surface waters and ground waters. Since all surface waters, 
whether rivers or lakes, are composed of the run-off, they must 
contain the impurities washed from the surface by the cleansing 
rains. These are carried either in solution or suspension, and, 
along with the inert organic or inorganic matter, there will always 
be found in every swallow of water some millions of bacterial 
organisms. As most of these are entirely harmless, we suffer no 
detriment, but occasionally they include some of the disease- 
producing bacilli, and then, if the system is in a susceptible condi- 
tion, sickness results. If in close communication with surface 
drainage, ground water is likely to be as fully contaminated as 
surface water, and often it is very much worse.'* 

"It is only from deep wells, wholly cut off from surface con- 
tamination, that water can be obtained absolutely free from bac- 
terial life. Such a supply is that of Memphis, Tenn., where the 
water comes from a large deposit of pure quarcz sand several hun- 
dred feet below the surface, from which it is separated by a thick 
stratum of clay. While artesian waters are likely to be charged 
with inorganic matter in solution, they are quite free from all or- 
ganic pollution and from all forms of bacterial life ; but since 
these sources are very exceptional, few cities can be supplied in 
this way, and the chief reliance must be upon surface waters. 
These, to be entirely healthy, must be freed from their bacteria. 
One of the greatest triumphs of sanitary science is the ability to 
do this, and it can be proved beyond a reasonable doubt that this 
purification is effected by filtration through fine sand." 

"Evidently this process does not consist of straining the 
water, for these organisms pass rapidly through the closest filter 
paper, and probably wherever water can go, so far as any me- 
chanical restriction is concerned. The action of a sand filter is 
something very different. Indeed, the efficiency of a sand filter 



68 SANITATION. 

depends upon the presence in the water of certain microscopic 
vegetable growths, which are collected on the sand grains on and 
near the top of the filter and there form a kind of porous blanket- 
covering, through which the water to be filtered must pass. This 
gelatinous cover is of a thick, spongy nature, and is itself a grow- 
ing vegetable, furnishing enticing habitations for the innumerable 
families of water bacteria which here find a home. These in turn 
attack and consume the organic matter in the water as it slowly 
moves down through this superficial blanket of living and hungry 
organisms, so that, after passing through this film, not over a 
quarter of an inch thick, the water is found to have lost not only 
its bacteria but a very large portion of its other organic matter." 

"All surface waters contain a sufficient number of vegetable 
spores to form a protecting coat in a few days, after which it is 
constantly renewed from the oncoming water. As the vegetable 
which forms the tough coating, and the all-consuming bacteria 
housed therein, die, they are at once consumed by the living gen- 
eration, which is ever increasing in numbers, until the passages 
between the sand grains become clogged with them, when this 
impervious purifying cover has to be removed and a new one 
allowed to form. In water containing a large amount of silt, like 
that of the Missouri river, which must first be settled to get rid 
of the mud to prevent immediate clogging of the sand filter, we 
find that a large proportion of the organisms which form the 
spongy cover, and also of the all-consuming bacteria, go down 
with the mud in the settling basins, and that it is likely to require 
a longer time and the passage of a larger quantity of such settled 
water through the filter to render it again effective, after a cleans- 
ing by removal of its top layer, than it does of water that was 
originally clear." 

It is thus seen that water, alive with micro-organisms, con- 
tains within itself the elements for its own purification, and that 
the sand filter furnishes the means for making them effective. 
The process is a bacteriological, not a chemical one. Water may 
be chemically pure, yet contain so many disease germs as to be 
very dangerous. Upon no scientific subject has there been a 
greater change of views during the last few years than that of 
water purification. It has been but a little while since animal 
charcoal and some other forms of carbon were thought ideal ma- 
terials for filters, because when fresh and in perfect condition 



SANITATION. 69 

they can strain out some colors from swamp waters and change 
claret into a colorless liquid, but it is now known that they can 
remove scarcely anything of a disease-producing nature, and are 
unable to promote any germicidal effects ; that asbestos filters 
are also worthless, and that very little confidence can be placed 
in any filter made from natural stone until that particular filter 
has been tested. At that time sand filters were thought of no 
value, bcause they remove but a small proportion of dissolved 
inorganic matter. Indeed, it was not until after the discovery 
of bacteria in water, and their relation to disease, that the real 
significance of water filtration began to be understood. 

Although a sand filter may strain out solids and make water 
clear, its most valuable service is that of destroying disease-pro- 
ducing bacteria by means of other bacteria, as already described. 
To do this most efficiently the filter must have been in opera- 
tion several days, not only that the sand may become firmly set- 
tled, but that the slimy, vegetable growth, swarming with bacterial 
life, may form over its surface. Let it be emphasized that it is 
in this covering that its chief value lies ; that here the principal 
purification of the water takes place ; and that when this film 
has been formed it will do good work until it and a thin layer 
of sand next to it have become so clogged as to cause too scanty 
flow, when a thin layer must be scraped from the top of the filter- 
bed and a new film allowed to form. At some large filters it is 
customary, as soon as the. clogged layer has been removed, to 
spread over the surface some of the sand scraped off at a previous 
cleaning, that its bacteria may hasten the growth of the new 
covering, and the period that the filter must remain idle thus be 
shortened. Meantime, the outlet is closed, and the surface of 
the filter-bed is kept covered with filtered water let in from below. 

Most of the purifying organisms require oxygen, hence, the 
use of the filter should be discontinued for an hour or two each 
day, the water drawn off, and the surface of the bed exposed to 
the air. With long use a gradual growth of the surface bacteria 
extends through the filter-bed, and so large a number of these 
organisms then appear in the filtered water as to make it neces- 
sary to renew all the sand. 

Although nearly all water bacteria are harmless to the human 
body, and many of the common, vigorous forms rapidly destroy 
disease bacteria, such as the germs of typhoid fever, when brought 



70 SANITATION. 

into contact with them, water that contains more than ioo of any 
kind of germs to the cubic centimeter (fifteen drops) is consid- 
ered unfit for use. When it is remembered that a filtrate of this 
degree of purity is likely to have contained many thousands of 
bacteria per cubic centimeter when it entered the filter, it can 
be readiiy understood that the modern sand filter, properly con- 
trolled, silently but surely perforins a most priceless service. 

As already indicated, it is impracticable, if not impossible, to 
make a filter with spaces between its grains smaller than the 
microbes. The medium sought is one with spaces so small that 
the microbes shall be retained by molecular attraction until they 
can attack and destroy each other. Sands of various" dimensions 
are used for this, but in general its grains should not exceed .015 
of an inch in diameter, and a smaller size is usually preferred. 
With everything in perfect order, a filter-bed of such sand a few 
inches in thickness is sufficient, but to guard against accidents 
and to assure reliable service for a long time, the large filter-beds, 
used in the purification of water supplies for cities, are usually 
composed of from 30 to 60 inches of fine sand, resting upon a 
few inches of coarse sand, underlaid by a few inches of fine gravel, 
with a layer of coarse gravel under all, that the filtered water may 
readily percolate through it to the outlet.* 

For effective bacterial work, filtration must be a slow process, 
and the efficiency of a filter will vary inversely with the quantity 
passed through it in a given time. To secure good results, the 
speed of the water as it passes through the fine sand should not 
exceed four inches per hour, under a pressure of three or four 
feet of water. 

The prevention of water-borne diseases by proper filtration 
has been so thoroughly demonstrated, we will pause to mention 
only one of very many convincing tests. Hamburg and Altona, 
in Germany, lie closely, side by side, on the right bank of the 
Elbe, and both take their water-supplies from that stream — 
Altona from a point seven miles below the sewers of both cities, 
Hamburg from about seven miles above. The raw water of 
Altona is thus polluted with the sewage of about 770,000 people, 

* Recent experiments with water excessively charged with bacteria indicate that 
deep filter-beds may sometimes be necessary, and emphasize the importance of sand 
action in germ destruction, as distinguished from the action of the sediment layer, by 
which it appears that while the surface film is the principal factor, it is not by any 
means the only agency in sand filtration. 



SANITATION. 71 

and generally contains from 20,000 to 40,000, sometimes 100.000, 
bacteria per cubic centimeter. The Hamburg supply, prior to 
1893, received no filtration, but that of Altona was purified by 
sand filters before delivery for domestic use. 

In August, 1892, some gypsies, among whom was a case of 
cholera, camped on the bank of the river, above these cities. An 
epidemic of the disease promptly broke 'out in Hamburg, causing 
in August and September 16,748 cases and 8,605 deaths. No cases 
occurred in Altona until December and January, when a slight 
epidemic came, caused, as Professor Koch afterward demon- 
strated, by contaminated water that had passed through cracks 
in the walls of the filter-beds, results of freezing. Although along 
a street forming the dividing line of the two cities, there were 
numerous cases on the Hamburg side in August and September, 
on the opposite side, among the residents supplied with the 
Altona filtered water, not a case of cholera occurred. In like 
manner, because of the freezing of its filter-beds, Altona suffered 
from typhoid fever during other winters, and, although the fever 
was constant in Hamburg, it appeared only at these times in 
Altona. But Hamburg still further illustrates the value of pure 
water. Roused by its cholera scourge, the city adopted most 
radical improvements, whereby its water supply, which is still 
taken from the same polluted stream, was so filtered that 
its death rate from typhoid fever, which had always been very 
large, has been reduced to only 6 in each 100,000 inhabitants. 

Filter galleries are trenches sunk below low water mark, ex- 
tending several feet to a reservoir, and filled with sand and gravel. 
They are very unreliable and likely to prove a source of danger 
and disappointment. 

Filtration by percolation is one of nature's chief methods of 
purifying water, and is more or less perfect, according to the 
medium through which the water passes. When perfect, all sus- 
pended matter, alive or dead, is intercepted. 

OTHER METHODS OF PURIFYING WATER. 

Nitrification, oxidation, sunlight, heat and cold are also 
nature's methods. 

Nitrification is a sequent of germ action, which, as we have 
seen, plays such an important part in the purification of water 
by sand filtration as to constitute its main factor. 



72 SANITATION. 

Oxidation is the action of atmospheric oxygen. Its power 
to change organic matter has been greatly overestimated. No 
river is long enough to purify its water in this way. Even the 
waters of Niagara are little changed by their tremendous leap 
through the air. 

Sunlight destroys many kinds of germs, and in this way is a 
purifier. 

Heat, as produced in nature, has little influence in purifica- 
tion. Results sometimes attributed to it and to oxygen are due 
to light. 

Cold cannot be relied upon to destroy many kinds of bacteria, 
or as a means of purification, although alternate freezing and 
thawing will diminish organic life, and cold hastens sedimenta- 
tion. Ice may be very impure and is a frequent means of convey- 
ing disease. Water will not "freeze pure." Many micro-organ- 
isms are not injured at all by freezing, but on thawing out awake 
to new activity, and, if taken into the alimentary canal, are liable 
to do deadly work. 

Distillation produces pure water, and though its expense pre- 
cludes its use on a large scale, there are small stills in the market 
capable of furnishing supplies for family use without much extra 
expenditure for fuel. (See Beverages, page 82.) 

Boiling is an easy method of destroying germs, thus rendering 
inert organic matter. All suspected water should be boiled twenty 
minutes before it is used for drink. The insipidity of boiled and 
distilled waters may be overcome by pouring several times 
through a pure atmosphere or by other means of aeration. Fil- 
tering through charcoal improves the taste. 

DOMESTIC FILTERS. 

A good domestic filter is needed in most households sup- 
plied with either rain or hydrant water. Most of those on the mar- 
ket require constant care and intelligent supervision, and nearly 
ail of them have no bacteriological value, hence, are practically 
worthless. A better one than most of those offered for sale can 
be made by placing a piece of thick, white flannel in the bottom 
of a large flower-pot, previously cleansed by scalding, placing on 
that a couple inches of fine gravel, on that a thin layer of coarse 
sand, then six or eight inches of fine sand over all, and well pressed 



SANITATION. ^3 

down. To be of any value it must operate slowly. A fruit jar, or 

large bottle, with a funnel in its mouth, makes a good receiver for 

the filtered water. 

RAIN WATER. 

Rain water includes all water that has been evaporated, con- 
densed and precipitated, whether as rain, snow, frost or dew. By 
many it is thought to be pure. But it is often very impure, for 
in passing through the air it absorbs gases, especially carbon diox- 
ide and ammonia, and brings down with it various atoms, always 
floating in the air. As these atoms are chiefly organic, rain 
water containing three grains of solid matter per gallon is con- 
sidered impure, although that amount in spring or well water 
might not be injurious. 

In cities, roofs are often covered with dust, containing a large 
amount of organic matter, and water collected from them may 
be very bad. A pure supply may be obtained by turning off the 
first rain-fall and passing the rest through a good filter. It is 
as difficult to obtain perfection in filters as in many other things, 
but a properly constructed sand filter, more nearly, perhaps, than 
any other, fills all the requirements for purifying rain water before 
it enters the cistern. 

A brick and cement, water-tight reservoir, five feet in diam- 
eter (or as much larger as the size of the roof and cistern may 
demand) and about ten feet deep, should be constructed. A vitri- 
fied pipe should form the outlet, and over its opening at the bot- 
tom of the filter should be placed pieces of brick or stone, to 
prevent the entrance of gravel. A six-inch layer of coarse gravel 
should then be spread over the bottom, over this a four-inch layer 
of fine gravel, next four inches of coarse sand, then about forty- 
eight inches of fine sand. A few bricks may be placed below the 
supply pipe to prevent the incoming water from tearing up the 
filter-bed. The remaining space will form a reservoir for storing 
the water gathered during a shower, until it can pass down through 
the sand. The more slowly this process is performed, the more 
efficient it is apt to be. Water will be less likely to pass down 
between the sand and the wall, thus escaping filtration, if there 
be built in the wall, about thirty inches from the bottom, a hori- 
zontal offset four or more inches wide, abruptly increasing the 
diameter, for the sand will pack more closely upon this horizontal 
surface than upon the vertical ones. 



74 SANITATION. 

Of course, the materials used must all be clean. It is not best 
to heat the sand, but if dirty it should be thoroughly washed before 
it is placed in the filter. When the surface of the fine sand 
becomes clogged, a thin layer should be scraped off, and replaced 
by clean sand. After a time the entire filter-bed must be taken 
out, and one made of fresh materials substituted. As much of 
the reservoir should be below the surface of the ground as the 
depth of the cistern into which it is to drain will permit. The top 
is best left open to the air and light, but, during winter, a few 
boards may be laid across, and the top and sides protected from 
frost by a covering of straw or similar material. If the filter-bed 
becomes frozen, water should not be admitted until the frost has 
thawed out. 

The cistern must be so constructed that no seepage can pene- 
trate its walls and no vermin enter from the top. The surface 
should slope from it in every direction. If made of brick or stone, 
though laid in cement, it should be at a safe distance from all cess 
and privy pits. The best material for it is iron, laid in sections 
with cement, and coated with tar. Probably the next best mate- 
rial is vitrified brick, laid in cement. The cover should exclude 
all contamination, and be equipped with a ventilator to admit pure 
air. No lead, zinc or galvanized pipes should be used about it. 
The pump should not rest upon the bottom, but terminate a few 
inches above it, suspended from the platform. The chain-pump 
rigged with small buckets which carry air down into the water 
every time that water is brought up, is the best yet devised for 
cistern use. 

Pure soft water is healthier than hard water, and is better 
for cleansing purposes, giving a fresher and more youthful appear- 
ance to the complexion and greater softness to the skin, but it 
dissolves both organic and inorganic matter more readily, hence, 
increased care is required to preserve its purity. 

TESTS FOR IMPURITIES. 

Only bacteriological tests conducted with great skill and care 
can certainly decide as to whether water contains disease germs, 
and in some cases careful chemical analysis is required to detect 
the presence of injurious inorganic elements, but there are several 
tests for impurities, so simple as to be made by anyone. In all 
examinations remember that the purity of the water in a well 



SANITATION. 75 

or reservoir differs at different depths. The surface ma}" be prac- 
tically pure, while, from sedimentation, there is great impurity 
at the bottom. 

Color. — Pure water, in a clean and clear glass bottle, when 
light shines through it on a dark background, will be clear and 
colorless. A faint blue tint is no evidence, however, of impurity, 
but a yellow tint is always suspicious. 

Odor. — Fill a bottle half full of the suspected water, cork and 
place it where it will keep warm a few hours, after which shake 
it and remove the cork. If it emits any odor, especially an un- 
pleasant one, the water should be further tested. 

Taste. — Water fresh from the well is usually tasteless, al- 
though it may contain putrescible matter. If pure, it should 
remain tasteless after it has been left in a warm place long enough 
for any organic matter it may contain to decompose. If any 
unpleasant taste develops, the water should be subjected to anal- 
ysis. 

Fermentation. — Into a clean glass bottle, filled with the sus- 
pected water, drop a pinch of pure white sugar, and put it in a 
warm place, leaving it uncorked. If in two days the water appears 
cloudy, it is impure and unfit for use. 

The Permanganate Test. — An excellent test may be made 
by putting into a glass-stoppered bottle two tablespoonfuls of 
water, three grains of permanganate of potash, and twelve grains 
of caustic potash. Y\ nen the potash has been dissolved, add a 
drop of the liquid to eight tablespoonfuls of the water to be tested, 
in a clear white bottle, and if the color changes to a brown, or 
in a few hours disappears, the water is too impure for drinking. 
In all tests be careful that everything used, except the water, shall 
be strictly clean. 

BATHING. 

Water must also be used for other than potable purposes. 
Cleanliness is next to godliness, because it tends to health, hap- 
piness and purity. This requires abundant water in every home, 
and its free use by every individual. So marvelous have been the 
results of cleanliness, through the free use of pure water, that in 
surgery they led at first to erroneous conclusions. Scientists 
believed the benefits were due to some specific germicide, and 
operating rooms were therefore flooded with solutions of carbolic 



76 SANITATION. 

acid, corrosive sublimate, and the like. Under the leadership of 
Lawson Tait, it was found that the rapid and healthy healings 
without inflammation or pus were due to thorough cleanliness, 
secured as readily by aseptic water as by the use of drugs. What 
is true of the prevention of disease in wounds, is true of its pre- 
vention everywhere. If the body, within and without, and all 
its surroundings, be kept pure, disease will be reduced to the 
minimum. 

The skin encasing the body performs many important func- 
tions. It is the most extensive membrane of the organism, and 
not only covers the body, but is reflexed, and lines all the cavities 
which open on its surface ; for although this inner lining is called 
mucous membrane, it is only skin turned in. The skin not only 
forms a covering and protection, but, through a delicate network 
of nerves, furnishes information as to the character of its sur- 
roundings. The hardened cells of its outer covering are contin- 
ually loosening, and, if not removed as dead organic matter, will 
decompose and perhaps be absorbed, for the skin not only absorbs 
oxygen, but the excretions of the body and other deleterious mat- 
ter that remains in contact with it. Hence, we must wash and be 
clean. 

We note progress in many lines of sanitary science, but in 
water supply we are behind the civilization of ancient Rome, which 
led the ages. Pure water brought from far-away mountains by 
its great aqueduct, literally flooded the city of seven hills, and its 
people understood its importance and use. Agrippa erected 177 
elegant baths, where the poorest Roman could lave without a 
farthing, and provided yet more luxurious ones at the charge 
of a penny, thus tempting to cleanliness every citizen. Rome had 
856 public baths, receiving 400,000,000 gallons pure soft water 
annually, and, as a corollary of this munificence, private wealth 
competed in the construction of baths, of splendor almost beyond 
modern conception, with another yet more important consequent ; 
— Pliny tells us that for six hundred years Rome needed no other 
medicine than her baths. She boasted then in the health and 
strength of her people. Her degeneration now finds a fitting 
sequent in the filthy, dwarfed and ungainly Italian immigrants 
that crowd the huts of our mining camps and cities. 

Would there were Agrippas in the great Christian cities of 
the modern world. W r hile we are doing much to ameliorate the 



SANITATION. 77 

condition of those struggling in life's unequal contest, there is 
everywhere failure to appreciate the importance of preventive 
medicine, especially in the supply and use of pure water. But the 
light is breaking slowly, and civilized nations are beginning to 
awake. In every first-class hotel, in many private houses, and in 
some tenements, there are approved bathing apartments, and pub- 
lic baths are scattered through most cities, but the price of the 
luxury is still generally beyond the reach of the poor, and too 
many brownstone fronts have baths for the family and guests, but 
deny them to those who cook the food, serve at the tables and 
care for the children. 

The rain bath meets all requirements for a public bath, and 
has much to recommend it. It requires a minimum amount of 
water and serves it to each bather fresh and pure, warm or cold; 
it occupies little space, is easily kept clean, and may be used in 
all weather at all seasons. The falling water should break into 
spray with just sufficient force to rapidly cleanse the body. 
Whether warm or cold, or both alternately, it produces grateful 
sensations, and, as it runs away, carries with it the impurities from 
the person. 

The necessary outlay for such baths is so small they should 
be supplied to every citizen at public cost. Any large establish- 
ment using steam can have them at little expense, where the 
workmen can quickly wash away the dirt and sweat, incident to 
their toil, and with such renewal of vigor that, on resuming work, 
they will return their employer more than a quid pro quo. Such 
bath houses should have a dozen or more rooms, each 6x8 feet, 
and high enough for proper water-fall. There should be both 
cold and warm water, admitted through easily managed' faucets, 
the floor should be of stone, slightly sloping, and adjoining each 
room should be a small dressing room provided with hooks, towels, 
brushes, soap, etc. As these rooms practically clean themselves, 
they require little supervision. 

Free public baths of this kind should be in every city, dif- 
ferent buildings for each sex, and located at convenient points. 
While their establishment opens a wide field for private charity, 
it should not be left for individual philanthropy, but be clone at 
public expense at all centers of population. Their prevention of 
disease, and the vigor and energy developed in the citizen, will 
abundantly repay the outlay. That some of our cities are begin- 
ning to move in this matter is one of the hopeful signs of the times. 



78 SANITATION. 

Any house can have, at small expense, a satisfactory shower 
bath. All that is needed is a tub in which to stand and a tin pail 
with straight sides, a perforated bottom and an air-tight cover 
soldered to its top, with a nozzle for receiving a cork. Fill the 
pail with water, hang it over your head and, by pulling a string 
attached to the cork, admit air above the water. Use care that 
the shower shall not be cold enough to produce a shock. 

The home of everyone who can afford it should contain a bath- 
room, so equipped that its use will be a luxury. Its windows 
should open into the outdoor air, its ventilation and plumbing 
be as perfect as possible, and its supply of water soft and pure. 

THINGS TO BE REMEMBERED ABOUT THE BATH. 

The bath should never be taken within two hours after a 
full meal, or when you are very tired, greatly exhausted, or chilly. 
The reaction will be the most perfect in the morning, but only 
a strong, healthy person should indulge in either a shower or tub- 
bath before breakfast. For early morning, the sponge bath is 
preferable. The temperature should be regulated by individual 
vigor and sensibility to that which is the most agreeable. Neither 
water nor air should produce chilliness, nor should the water be 
very hot. If there are chilly sensations, the bath should be very 
brief. 

Those suffering from lesions of internal organs, especially of 
the heart or lungs, should avoid cold baths, or gradually educate 
themselves to their use. Aged people should always avoid them. 
Cold baths should not be taken during menstruation, but warm 
baths may then be beneficial, both by promoting cleanliness and by 
stimulating the discharges. A bath should never be continued 
until it enervates, or interferes with reaction. The average length 
of a warm bath should be from a quarter to a half hour, that of a 
cool bath less, that of a cold one much less. Never drink freely 
of cold water just before a bath, and always rub after a bath until 
both dry and warm. In healthy persons reaction may be hastened 
and a pleasant glow of warmth secured by a spray of cold water, 
showered over the body after the bath and followed by free fric- 
tion with coarse towels. Violent exercise immediately after a 
bath is not desirable, but the vigorous may be benefited by a 
brisk walk, or other movements, to quicken the circulation and 
restore a normal temperature. The whole body should be bathed 
every day, or at least two or three times a week. 



SANITATION. 79 

A little baking soda, ammonia or good soap added to the bath 
makes it more refreshing, since by cutting the oil and other excre- 
tions, it leads to a more thorough cleansing oi the skin. Baths 
of milk, koumiss, beer, wine and blood have all had their advocates, 
but the best authorities agree that none are better than those com- 
posed of water. The special benefits derived from ocean baths, 
mineral baths, etc., may be due in part to the stimulus of their 
salts and minerals, but their chief value is in the outing which 
their use implies. The change in diet and surroundings, the rest 
of body and mind, the cheerful and healthful environment, and the 
hygienic effects of any kind of water properly used, are the impor- 
tant factors. 

The "dry bath" a bath without water, is an approved method 
of stimulating the peripheral circulation, hence, of removing rem- 
ora and recent congestions, and consists of free friction over the 
whole body, as by a dry towel, continued until the skin feels like 
polished ivory. It is a logical and generally successful method 
of equalizing the circulation and removing colds. 

Vapor or steam baths are often very useful, for by promoting 
perspiration and other excretions, the}' cleanse the whole system. 
Various devices and costly cabinets are offered the public, but, for 
most practical purposes, the following contrivance is as good as 
any of them : On two slats support a basin ot water just below 
the seat of a cane-bottomed chair, and beneath the basin place 
a lighted lamp (an alcohol lamp is best), then sit in the chair, 
cover yourself, chair and all, with a large blanket, gathering it 
tightly about the throat and letting its lower edge rest upon the 
floor. When steamed to your fancy, spray the body with cold 
water, rub thoroughly with dry towels, dress warmly and avoid 
draughts and other means of taking cold. 

Swimming combines a general bath with vigorous exercise, 
and, therefore, may be continued longer than would be safe in 
water of the same temperature in a tub. Under proper condi- 
tions it is healthful and invigorating, but it should not be overdone. 
Young people, especially, are inclined to remain in the water too 
long. Unless the water is very warm, the stay should not be 
over twenty minutes, even for the most vigorous. Entering- the 
water when exhausted by severe exercise is likely to cause con- 
gestion, and is very dangerous, but heating the body by outside 
influences, such as hot air, is good preparation for a bath, and 
promotes healthy reaction at its termination. 



CHAPTER VI. 
DIET. 

By Louis C. Duncan, M.D. 

Foods serve the human body in two ways, one of which is 
the replacement of the worn-out tissues. This might, at first, 
seem their only use, but another service, equally important, is 
the furnishing of heat and force — keeping the body warm and 
giving it strength. Before an engine can furnish power, fuel 
must be consumed and heat transformed to force ; and before the 
body can have energy, food must be consumed, resulting in a 
similar production of heat and force. The first named service, 
by replacing worn-out parts, enables the body to perpetuate itself; 
the second, by furnishing power, gives it strength to meet the 
various demands thrust upon it. 

These two requirements are met by two classes of foods : — ■ 
The nitrogenous, and the non-nitrogenous. 

The Nitrogenoiis Foods, so called because they contain nitro- 
gen, meet the first demand — that of replacing worn-out tissues 
and building up the body. They are also known as albuminous 
foods and as proteids, the latter being their most common name. 
Lean meats, eggs, casein of milk, and gluten of grains, are of this 
class. 

The Non-nitrogenous Foods, those which contain little, if 
any, nitrogen, meet the second demand, and are of two kinds — 
the fats, including the oils, and the starches, including the sugars. 
The principal non-nitrogenous foods are the grains, flour, meal, 
vegetables, rice, fruit, cream, butter, fat, meat and oils. They pro- 
duce animal heat and energy, and may be stored up in the tissues 
as superfluous fat. The starches and sugars are often called 
carbo-hydrates. 

The above classification must not be taken as absolute and 
exact. When speaking of a class of foods as "force producers," 
we do not mean that they may not also be of some use in the econ- 
omy of repair, but that their chief function is the production of 
force. So, too, the tissue-building foods may also bear a small 

80 



SANITATION. 81 

part in the production of heat and energy. Most, if not all, foods 
contain both proteid and non-nitrogenous elements, their per- 
centages differing widely. Thus, the proportion of these parts 
in beef, milk and wheat are as follows : — 

Water and -r, ,. j- Non-Nitrogenous 

Minerals. *roteia*. Elements. 

Beef 57-oo 27.60 15.30 

Milk 87.52 4.48 8.00 

Wheat 15.60 14.60 59.58 

From the foregoing it will be seen that a mixed diet is a 
necessity, because the body demands both nitrogenous and non- 
nitrogenous food, and a little study of the above table will show 
that in general there is nothing to be gained by adhering to a 
vegetable diet. Though in varying proportions, the great staples, 
wheat, milk and beef, all contain the same elements. Thus, beef 
contains twice as much of the proteids as there is in wheat, but 
only about one-fourth as much non-nitrogenous matter (starch). 
Now, as baked bread contains a little less than half as much of 
the proteids as there is in an equal weight of wheat, if we eat 
bread alone we must take four times as much of it as we would 
of beef to get an equal quantity of proteids, and in so doing would 
overload the stomach with starch, getting about eight times as 
much as we would m eating the beef; but, by eating beef only, 
Ave would have to take an excess of proteids in order to get 
enough starch. Hence, we see that either bread or beef, as an 
exclusive diet, is likely to do harm by overloading and derang- 
ing the digestive system with one food element if we would 
get enough of the other. A judicious mixture of the two 
classes of foods will most economically secure the proper develop- 
ment of the body, and maintain good health and the maximum 
energy. 

As the starches and fats produce heat, it is evident that they 
should not be taken in fevers, but that the proteids, which restore 
and maintain the tissues without evolving much heat, will then 
be indicated. The proteids, since they contain nutriment in more 
concentrated form, and, in general, are more easily digested, are 
best in nearly all kinds of sickness. On the other hand, a healthy 
body in cold weather will require fats and starches. Except in 
a few conditions, the fats are more easily digested and assimilated 
than the starches. 

6 



82 SANITATION. 

The Inorganic Foods. — Besides the two great classes of foods 
just mentioned, there is another class, known as inorganic foods. 
It consists of water and the various salts, and, although, strictly 
speaking, these substances are not foods, they, nevertheless, fill 
very important places in the human diet. As it is water that 
gives to the blood, serum, sweat, and other fluids of the body 
their fluidity, and constitutes 76 per cent of the muscular tissues, 
and is the common carrier which bears the nutrients to and the 
waste from the various parts, the reasons readily appear why it 
is so indispensable to animal life. 

The salts pass into the blood, unchanged, hence it is only 
necessary that they be in a state of solution to be absorbed when 
they come > in contact with the lining of the alimentary canal. 
Many of them are already held in solution in the water we drink, 
but an additional amount is usually needed and is added to the 
food to render it palatable. The chief of them is common salt 
(Na CI), and is a varying quantity. It does five things for us 
and our food : — It renders it more palatable ; lessens putrefaction ; 
stimulates the flow of some of the gastric juices; by its affinity for 
water promotes the flow of it into the intestinal canal, thus assist- 
ing in the liquefaction of the foods ; and, lastly, promotes osmosis, 
i. e., the mucous membrane lining the stomach and intestines per- 
mits a more complete and rapid passage through it of the liquefied 
foods, for being covered with a salty fluid. It is essential that food 
for the sick, as well as for the healthy, be properly salted. Certain 
minerals, as magnesia and lime, assist in the building process, 
and other articles besides salt, as acids, alcoholics and spices, are 
taken to stimulate the appetite, to render the food more palatable, 
or to aid digestion, but cannot themselves be properly called foods. 

BEVERAGES. 

Milk. — Of all beverages, milk is the best. Besides satisfying 
thirst, it furnishes the body with real nutriment to the amount 
of about 13 per cent of its bulk. 

Water. — Water, of course, is one of the best of drinks. Pure 
water simply quenches thirst, but absolutely pure water is never 
found in nature, and, as already seen, the various wholesome salts 
usually held in solution in water serve a good purpose. Hence, 
water purified by proper filtration, or by boiling, is likely to be 
better than distilled water for drinking purposes. Indeed, unless 



SANITATION. 83 

it contains poisonous solutions, or wholesome salts in excess, 
drinking water should not be distilled, for distillation impairs the 
taste and removes the salts and minerals essential to health. The 
various mineral waters are useful in many cases, but we have not 
space for their discussion. 

Coffee and Tea. — Though in almost universal use, coffee and 
tea are not at all necessary to health and strength. The highest 
mental and physical efforts are possible with no other beverage 
than water. Coffee and tea contain very little nourishment, but, 
because of their stimulating effects, are very useful to soldiers 
and others undergoing great fatigue. After a day of severe 
physical effort without food, there is nothing else as grateful as 
good strong coffee. It is slightly laxative, while tea is astringent. 
The habitual coffee drinker suffers from headaches when without 
it, but soon becomes accustomed to the loss. It is claimed that 
strong coffee in the morning keeps off malaria; in the evening 
it often keeps off sleep. Strong, black coffee is an antidote to 
opium poisoning. It may safely be said that coffee and tea, of 
moderate strength and quantity, are not injurious, and may be 
beneficial by quieting the nervousness and mental unrest of 
fatigue and anxiety. Persons traveling, or in any way subject 
to great exposure and strain, should drink plenty of good coffee, 
but no alcoholics. Soldiers of the United States army, on travel 
rations, are allowed twenty-one cents each per day for coffee. 

Cocoa and Chocolate. — Cocoa contains much nutritious mat- 
ter of an oily nature, somewhat difficult to digest, and, as much 
boiling separates its elements and makes them still harder to 
digest, it should never be allowed to boil longer than five minutes. 
Chocolate should never be allowed to boil at all. In cases of con- 
sumption and other wasting diseases, either is an excellent drink, 
and when possible should be included in the diet. 

Deer, Ale and Porter. — These are fermented liquors made 
from malted grains, and contain from 2 to 6 per cent of alcohol. 
The mildest of all the alcoholics, a moderate amount of them 
may be taken daily without injury, unless a morbid desire be cre- 
ated by their use. They have very little nutritive value, but 
increase the appetite, and favor the formation of fat. In large 
quantities they cause fatty degeneration of the organs, especially 
of the liver and heart. The fat of the beer drinker is not a healthy 
fat, and does not represent stored-up vitality. These drinks are 



84 SANITATION. 

not prescribed in acute diseases, but are useful in convalescence, 
and in chronic wasting diseases; as consumption, protracted sup- 
puration, long continued nursing, scrofula and diseases of ■ the 
joints. 

Wines. — Wines are made by fermenting the juice of the 
grape, and contain from 5 to 25 per cent of alcohol. Some wines, 
as Port, have alcohol, added during the process of manufacture; 
some such ''fortified" wines containing as much as 30 or 40 per 
cent. Wines usually contain from 3 to 25 per cent of sugar, but 
dry wines are free from sugar. Foreign wines are in no way 
superior to our native wines. A glass of either, taken during 
the course of a meal, often aids digestion. Wines do good in 
diarrhea and! dysentery, anemia and chlorosis, convalescence and 
chronic wasting diseases ; in various acute diseases and conditions, 
with great weakness and feeble heart, they are highly useful. 
Such occasions are met in pneumonia, pleurisy, typhoid and other 
fevers, profuse hemorrhage, severe injuries and surgical opera- 
tions. 

Brandy and Whisky. — These liquors are distilled from the 
juices of fruits and grains. Brandy contains from 40 to 47 per 
cent alcohol, and whisky, from 45 to 50 per cent. Neither is 
suitable for a beverage, but both are useful in diseases and injuries. 
They may be used in cases where wine /is useful, but something 
stronger is required. They are indicated in all chronic, wasting 
diseases, and are prompt antidotes to the poisoning of aconite, 
digitalis, conium, and the bites of poisonous serpents, but, to be 
of value in any of these cases, must not be given to intoxication. 
As soon as that point is reached, they should be discontinued, to 
be renewed as soon as the intoxication has disappeared, and the 
process is thus to be continued until the poison has been over- 
come. 

It cannot be denied that the employment of alcoholics of any 
kind is accompanied by danger of the patient's becoming addicted 
to their use. This objection, therefore, should always be con- 
sidered, and, except to elderly people, or in cases of great need, 
they should be administered very sparingly, if at all, and for a 
brief time only. 

THE DIET IN HEALTH. 

A quart of milk, three-fourths of a pound of good beef, and 
five ounces of wheat flour, severally contain about the same 



SANITATION. 85 

amount of nutritive material. Milk contains every element 
needed by the human body, and comes nearest to being a perfect 
food. The quantity needed as a complete diet for an adult is 
about one and a half gallons per day. Y\ neat bread also con- 
tains all the necessary ingredients, and though not in the proper 
proportions, when taken alone will sustain life. Although it 
would be an imperfect diet, a man could live on beef alone, but 
beef and wheat bread together make the essentials of a perfect 
diet — form its foundation and body, all other parts being but 
additions and adornments to give variety, stimulate the appetite, 
etc. A study of the composition of these two great staples of 
diet logically leads to this conclusion, and all experience con- 
firms it. 

The amount of food daily required in health, and the proper 
proportion of its nitrogenous and non-nitrogenous parts, have 
been made the subject of much investigation. The tables of 
Professor Voight of Munich are generally accepted by scientific 
men. They show the following as the proper average amount 
per day: — 

Starches 
Proteids. Fats. and Sugars. Total. 

Man with light exercise 22 lbs. .22 lbs. .88 lbs. 1.32 lbs. 

Man with moderate labor 28 " .28 " .98 " 1.54 " 

Man with hard labor. 33 " .33 " 1.10 " 1.76 " 

COMPOSITION OF FOOD MATERIALS. 
Showing proportions of waste, water and nutritive parts. 

Nutritive 
Food, Waste. Water. Material. 

Beef — Neck , 20. 49.6 30.4 

Shoulder 12.6 55.8 31.6 

Chuck-rib 14.6 49.5 35.9 

Rib 21. 38.2 40.8 

Sirloin 19.5 48.3 32.2 

Round 7.8 60.9 31.3 

Side 19.2 44.3 36.5 

Rump (corned) 5. 70.8 24.2 

Flank (corned) 12. 1 43-7 44.2 

Veal— Shoulder 17.9 56.7 25.4 

Mutton — Shoulder 16.3 49. 34.7 

Le g 18.1 50.6 31.3 

Loin 15-8 4i-5 42.7 

Slde 173 44-2 3%-5 

Pork— Fresh I4 .6 43. 42.4 

Salt Ham 11.4 36.8 51.8 

Chi cken 3 8. 2 44.6 17.2 



86 



SANITATION. 



Food. Waste. 

Turkey 3~-4 

Eggs 137 

Bluefish (dressed) 45-9 

Mackerel (whole) 44.8 

Halibut (dressed) 177 

Salt cod 42.1 

Salt mackerel 40.4 

Canned salmon 4.9 

Lobsters 62. 1 

Oysters 82.3 





Nutritive 


Water. 


Material. 


447 


22.9 


63.1 


23.2 


43- 


II. I 


40.2 


15. 


61.9 


20.4 


40.5 


17.4 


28.1 


3i-5 


59-3 


35-8 


31. 


6-9 


15-4 


2.3 



COMPOSITION OF FOOD MATERIALS. 

Showing percentage of water, nutrients and 
freed from bones, skin, shell and other refuse: 

Food. Water. Proteids. Fat. 

Beef — Neck 62. 19.5 17.5 

Rib 48.1 15-4 35-6 

Sirloin 60. 18.5 20.5 

Round 68.2 205 10. 1 

Veal shoulder 68.8 20.2 9.8 

Mutton leg 61.8 18.3 19. 

Pork — Shoulder 50.3 16. 32.8 

Smoked ham 41.5 16.7 39.1 

Salted ,. 12.1 .9 82.8 

Fresh sausage 41.5 13.8 42.5 

Chicken 72.2 24.4 2. 

Eggs 73.8 14.9 10.5 

Milk 87. 3.6 4. 

Butter 10.5 1. 85. 

Oleomargarine 11. .6 85. 

Cheese, full cream 30.2 28.3 35.5 

Cheese, skimmed milk 41.3 384 6.8 

Salt mackerel 53.7 17.3 26.4 

Oysters 87.1 6. 1.2 

Wheat flour 12.5 11. 1.1 

Graham flour 13. 1 11.7 1.7 

Oatmeal 7.6 15. 1 7.1 

Cornmeal 15. 9.2 3.8 

Rice 12.4 7.4 .4 

Peas 12.3 26.7 7 

Beans 12.6 23.1 2. 

Potatoes 78.9 2.1 .1 

Sweet potatoes 71. 1 1.5 .4 

Turnips 89.4 1.2 .2 

Onions 87.6 1.4 .3 

Apples 832 .2 .4 

Cabbage 91.0 2.1 .3 

Sugar, granulated. . , 2. .... 

White bread 32.3 8.8 1.7 

Boston crackers 8.3 10.7 9.9 



minerals when 



Starch Mineral 
nd Sugar. Matter, 




1. 




9 




1. 




1.2 




1.2 




9 




•9 




2.7 




4.2 




2.2 




1-4 

.8 


4-; 


' -7 


c 


S 3- 


iX 

8.9 


1 3- 

I 4.2 
4.6 
2.6 


3-; 


7 2. 


74< 

71-: 

68.. 


? -5 
7 1.8 
2 2. 


7o.( 


5 1.4 


79- 


1- -4 


57- 


\ 2.9 


59- 


! 3-1 


I7.( 
26. 


} I. 
I. 


8.; 


> I. 


10. 


[ .6 


15 < 


) -3 


5- 


5 11 


97. i 
56. 
68.; 


5 .2 

5 -9 

7 2.4 



SANITATION. 



87 



THE HEAT-PRODUCERS. 

The comparative heat-producing values of various foods is 
shown by the table below. The unit of heat is the caloric. A 
caloric may be defined as the amount of heat necessary to raise 
the temperature of a pound of water four degrees Fahrenheit. 

One pound of proteids will produce 1,860 calori. 

One pound of fats will produce 4,220 calori. 

One pound of carbo-hydrates will produce 1,860 calori. 

The amount of heat and energy required per day is : — 

For a man with light exercise, 2.980 calori. 

For a man with moderate muscular work, 3.520 calori 

For a man with severe muscular work, 4,060 calori. 



TABLE SHOWING FUEL VALUES PER POUND. 



Calori 

Beef, sirloin 970 

Beef, round 855 

Beef, rib 1,405 

Beef, shoulder 895 

Veal, shoulder 640 

Mutton, leg 935 

Fresh pork 1-435 

Smoked ham 1735 

Chicken 330 

Turkey 550 

Eggs 655 

Salt codfish 315 

Salt mackerel 910 

Canned salmon 1,005 

Oysters 40 

Cheese, whole milk 2.150 

Butter 3.615 

Milk 670 

Molasses 1.320 



Calori 

Wheat flour 1,645 

Graham flour 1,625 

Rye flour 1,625 

Buckwheat flour 1,605 

Oatmeal 1,850 



Cornmeal 

Rice 

Peas 

Beans 

Potatoes 

Sweet Potatoes 
Turnips 



1.645 

1,630 

1,565 

1,616 

370 

530 

185 

Onions 225 

Tomatoes 80 

Cabbage 155 

Apples 315 

Sugar, granulated 1,820 

Wheat bread 1,280 

Crackers 1,895 



AMOUNT OF NUTRIENTS WHICH ONE DOLLAR WILL BUY. 



Food. Price. 

Beef, sirloin, per lb. 15c. 

Beef, round, per lb 10c. 

Beef, neck, per lb 8c. 

Mutton, leg, per lb 14c. 

Smoked ham. per lb 16c. 

Salt pork, per lb 10c. 

8c. 

IOC. 



Salt codfish, per lb 

Salt mackerel, per lb 

Oysters, per qt 35c 



Total 
Weight. 

6.67 
10. 

12.50 
7.14 

6.25 

10. 

12.50 

10. 

5-72 



Nutrients 
2.14 
3-13 

3 So 

2.23 

3-23 
8-37 
2.17 

3-15 
.62 



SANITATION. 



Food. Price 

Eggs, per doz 15c 

Milk, per qt 5c 

Cheese, whole milk, per lb 15c 

Butter, per lb 15c 

Butter, per It) 25c 

Sugar, granulated, per lb 5c 

Wheat flour, per lb 3c 

Wheat bread, per lb 5c 

Cornmeal, per ib 2c 

Oatmeal, per lb 5c 

Rice, per lb 8c 

Beans, per lb 5c 

Potatoes, per bu 50c 

Apples, per bu 50c 

Crackers, per lb 10c 

Chickens, undressed, per lb 8c 

Turkeys, undressed, per lb 8c 



Total 




Weight. 


Nutrients 


11.30 


2.63 


40.00 


4-99 


6.67 


4-37 


6.67 


579 


4.00 


346 


20.00 


I9-56 


33-33 


29. 


20.00 


I3-36 


50.00 


41.80 


20 


18.08 


12.50 


10.90 


20 


16.86 


120 


24.12 


112 


18.48 


10 


8.93 


12.50 


2.16 


12.50 


2.86 



BILLS OF FARE. 

The quantities of various articles which will furnish the proper 
medium amount of proteids, fats and starches for the daily diet 
of the average man at moderate labor, is shown in the following 
schedules, together with their approximate cost, as given in the 
foregoing table. Each will furnish about three pounds of gross 
food, and about one and a half pounds of pure nutrient material : 



I. 

Round steak 13 oz. 

Butter 3 oz. 

Potatoes 6 oz. 

Bread 22 oz. 

Cost, 24 cents. 

II. 

Salt pork 4 oz. 

Butter 2 oz. 

Bread 18 oz. 

Beans.. 16 oz. 

Cost, 14 cents. 

III. 

Sirloin steak 12 oz. 

Butter 3 oz. 

Potatoes 12 oz. 

Flour 12 oz. 

Milk 1V2 pints. 

Cost, 29 cents. 



IV. 

Ham 12 oz. 

Salt pork V2 oz. 

Butter .* 1 oz. 

Potatoes 8 oz. 

Beans 5 oz. 

Flour 12 oz. 

Cost, 18 cents. 

V. 

Chuck steak 10 oz. 

Ham 6 oz. 

Eggs 2 oz. 

Flour 8 oz. 

Butter 2 oz. 

Potatoes 12 oz. 

Sugar 1 oz. 

Milk 1 pint 

Cost, 26 cents. 

VI. 

Round steak 6 Oz. 

Mackerel 12 oz. 



SANITATION. 89 

Butter 2 oz. Egg i oz. 

Cheese I oz. Butter 3 oz. 

Potatoes 8 oz. Potatoes 12 oz. 

Oatmeal 1 oz. Turnips 4 oz. 

Wheat fxour . . 8 oz. Canned corn 4 oz. 

Graham flour 4 oz. Oatmeal 1 oz. 

Sugar 2 oz. Rice 1 oz. 

Milk 1 pint Wheat flour 4 oz. 

Cost, 27 cents. Graham flour : 2 oz. 



VII. 



Sugar 3 oz. 



Pork chop 8 oz. Milk % P in t 

Liver 8 oz. Cost, 30 cents. 

DIGESTIBILITY OF FOODS. 

The amount of nutrition which any article of food contains 
is quite independent of the time required for its digestion, thus, 
rice, which is digested in an hour, has more than seven times the 
nutritional value of boiled cabbage, the digestion of which re- 
quires four and a half hours ; and fried salt pork, which takes four 
and one-fourth hours, contains more than five times as much 
nutrition as an equal weight of fresh apples, digested in one and 
a half hoars. 

In 1822, Alexis St. Martin, a Canadian voyageur, 18 years 
old, received a charge of duckshot in such a manner as to blow 
away a portion of the covering of his abdomen, and make a hole 
about an inch in diameter in his stomach, and, although under 
the care of Dr. Beaumont, a surgeon of the United States army, 
his wound entirely healed and he fully regained his health, mar- 
ried, reared a family, chopped and did other hard labor, and lived 
to the age of 84 years, the hole in his stomach never closed. It 
was partly closed, however, by a curtain or fold of mucous 
membrane which grew down inside, that was easily pushed back 
by his physician as often as he wished during a long and exceed- 
ingly interesting series of experiments, which shed more light 
upon the exact functions and mechanism of the stomach, and 
its mode of working, its secretions and their functions in 
the digestive process, than had been learned in all the centuries 
before. 

The time required for the digestion of various articles of 
food, as thus ascertained by Dr. Beaumont, is given in the follow- 
ing table : 



90 



SANITATION. 



THE TIME REQUIRED TO DIGEST VARIOUS FOODS. 



Pigs' feet . 

Tripe 

Rice, boiled 

Eggs, whipped 

Salmon-trout 

Barley soup 

Venison, broiled 

Apples, sweet, mellow, raw. 
Apples, sour, mellow, raw. . 
Codfish, cured, dry, boiled. 
Liver, broiled 



H. Min. 



30 
30 
30 
30 
30 

2 
2 
2 



Milk, boiled 2 

Beans, boiled 2 

Tapioca 2 

Milk, raw 2 15 

Turkey, boiled 2 25 

Turkey, roasted 2 30 

Goose, roasted 2 30 

Lamb, fresh, boiled 2 30 

Beans, green, boiled 2 30 

Cabbage, raw 2 30 

Potatoes, Irish, baked. 2 30 

Parsnips, boiled 2 30 

Hashed meat and vegetables. . . 2 30 

Custard, baked 2 45 

Beef, salted, boiled 2 45 

Apples, sour and hard, raw. ... 2 50 

Oysters, fresh, raw 2 55 

Eggs, soft boiled 3 

Bass, fresh, broiled 3 

Beef, fresh, lean, rare, roast... 3 

Beefsteak, broiled 3 

Mutton, fresh, boiled 3 

Mutton, fresh, broiled 3 



H. Min. 



Soup, bean, boiled 3 

Dumpling, apple 3 

Corn cake 3 

Carrot, orange, boiled 3 

Corn bread 3 

Mutton, fresh, roasted 3 

Pork chop, broiled 3 

Oysters, fresh, roasted 3 

Eggs, hard boiled 3 

Eggs, fried 3 



Oysters, fresh, stewed 3 

Beef, fresh, dry roasted 3 

Beef with mustard, etc., boiled. . 3 

Oyster soup, boiled 3 

Chicken soup, boiled 3 

Butter, melted 3 

Cheese, old, strong, raw 3 

Mutton soup, boiled 3 

Turnips, boiled 3 

Potatoes, Irish, boiled 3 

Beets, boiled 3 

Corn and beans, green, boiled. . 3 

Beef, fresh, lean, fried 4 

Salmon, salted, boiled 4 

Veal, fresh, broiled 4 

Fowls, domestic, boiled 4 

Fowls, domestic, roasted 4 

Pork, recently salted, fried 4 

Beef, old, hard, salted, boiled.. 4 

Veal, fresh, fried 4 

Cabbage, boiled 4 

Duck, wild, roasted 4 

Pork, boiled 4 

Pork, roasted 5 



15 
15 
15 
15 
15 
30 
30 
30 
30 
30 
30 
30 
30 
30 
30 
30 
30 
45 
45 



15 
15 
30 
30 
30 
30 
15 



It has also been learned that food digests most quickly when 
very finely divided, as by thorough chewing; when eating is fol- 
lowed by a period of rest ; and when little liquid is taken at the 
time of eating; also that digestion is retarded when food is taken 
when there is great bodily fatigue, or during strong emotion 
or excitement. Articles fried in fat are generally hard to digest. 
Food should not be eaten either very hot or very cold, it should be 
eaten at regular hours, and there should never be" any piecing 
between meals. 



CHAPTER VII. 

THE TEETH. 

By Alfred C. Sloan, D.D.S. 

Standing at the outer portal of the human body, the teeth 
give beauty, symmetry and expression to the face, but their princi- 
pal office is the performance of the main portion of the mechani- 
cal part of digestion. By grinding the food into small particles 
and mixing it with the saliva, they reduce it to the condition most 
susceptible to the action of the stomach and intestines. When 
some of the teeth become diseased, or are imperfect, or missing, 
the remainder are unable to properly perform the duty of all, and 
the food goes to the stomach in much the same condition as that 
eaten by birds, and the pangs of indigestion with its train of ills 
result. 

It is fully established that diseases of the teeth, as well as 
most other diseases, are due to germs. The mouth is an ideal 
breeding place for micro-organisms, since its warmth, moisture 
and abundant food, all favor their unlimited multiplication and 
development. Food passed into the stomach through a filthy 
mouth is in no condition to produce pure healthy blood, for from 
diseased, carious and abscessed teeth the food is mixed with 
the debris of decay, and ferments or poisonous, disease-produc- 
ing bacteria. When long continued these causes alone are suffi- 
cient to produce serious derangements of the alimentary canal; 
and many cases of blood poisoning, by pus from diseased teeth, 
are recorded in medical and dental literature. 

From these facts it may be seen what dire results may follow 
neglect, and how important it is that the teeth should receive intel- 
ligent care. This should date from the time when the first ones be- 
gin to appear, which, usually, is when the child is from six to eight 
months old. The first to arrive are the central incisors; then 
the lateral incisors, first molars, cuspids and second molars come 
in the order named, the last ones appearing at from the eighteenth 
to the twenty-fourth month, and completing the temporary set — 
twenty in all, ten above and ten below. 

9* 



92 sanitation: 

The mother should give her careful personal attention to the 
teeth of the baby, always remembering that a tooth is not complete 
when it emerges from the gum, and that it will be a good year 
and a half later before its roots are fully formed. Wrap a piece 
of soft linen around the finger and gently cleanse the baby's 
teeth. When the eight front teeth are all in place, a badger's hair 
baby tooth brush may be substituted, for these brushes are so 
soft as to do no harm. Brush from the gum towards the cutting 
edge, thus removing the particles of food from between the 
teeth, and when the back teeth come, brush their grinding surfaces 
as well as their sides. It has been positively proven not only 
that caries in teeth is due to micro-organisms, but that a colony 
of these germs forms lactic acid abundantly in twenty-four hours, 
and that this acid by acting directly upon the tooth produces its 
decay. The germs find lodgment in the seams and pits on the 
grinding surfaces of the back teeth and between the teeth, hence 
the necessity of cleansing them thoroughly in all their parts. 
Have decayed teeth filled, thus stopping further decay, and have 
those crowned that have gone too far to be filled. 

THE TEMPORARY TEETH. 

The preservation of the temporary teeth of the child is a 
matter of much importance. Remember that he has but twenty 
teeth, while you have thirty-two, sixteen in each jaw, and that 
thorough mastication of food is as essential to him as to you, for 
which reason alone the loss of one tooth would be a serious mat- 
ter; but there is another very important reason for preserving as 
long as possible the first teeth, and that is the injury which their 
early loss exerts upon the dental arch. The teeth are partly 
held in place by the lateral pressure exerted one upon another. 
When one is removed this mutual support is gone, and gradually 
the teeth nearest the opening are crowded into it, until, as often 
happens, the vacant space is entirely obliterated, hence when the 
permanent tooth for this place is formed it is forced out of the 
arch, and a crooked deformity results. 

As the permanent teeth develop, the roots of the temporary 
teeth are absorbed to make room for them, but the roots of a 
temporary tooth whose nerve has died are not absorbed and, there- 
fore, become an obstruction to the eruption of the new tooth, 
forcing it aside and causing a serious malformation. Do not think 



SANITATION. 93 

it money ill spent to have the first teeth filled and thus preserved as 
long as possible. As soon as a cavity shows itself have it filled, 
instead of waiting until the tooth aches, and your child will not 
be hurt, then when the time arrives for the permanent teeth to 
come, the roots of the temporary ones will be entirely absorbed 
so that their crowns can be picked off without pain, and a set of 
new teeth, symmetrical and beautiful, will develop in their place. 
The common practice of pulling the child's teeth with a cord or 
other device, as fast as they begin to loosen, is a most pernicious 
one, and results in irreparable distortion of the second teeth, if not 
of the jaw itself. 

Tooth Powders are numerous, but none excels precipitated 
chalk, a preparation to be had for a few cents at any drug store. 
It is a soft, tasteless antacid, absolutely non-injurious and when 
systematically used is one of the best, if not the very best, of all 
the preservatives of dental structures. It removes any light dis- 
coloration, but will not remove dark heavy stains or tartar, and 
any preparation that will, or that is advertised to do it, should be 
shunned, for its use cannot be other than injurious to the teeth. 
Have nothing to do with it. 

If in place of the chalk you wish a nicely flavored dentifrice, 
use Oraline Tooth Paste, prepared by the S. S. White Mf g Co., 
or Enthymol Tooth Paste, put up by Parke, Davis & Co., for 
neither of these will in anyway injure your teeth. 

Mouth-washes. — When you have decayed teeth, or inflamed 
spongy gums, with an unpleasant taste, and odor to the breath, a 
mouth-wash is needed in addition to the dentrifice. An excellent 
one can be made by adding to either Listerine, Enthymol, Boro- 
lyptol or Pastrine three times its volume of water. After cleansing 
the teeth, thorough!) rinse the mouth with this wash, and if there 
is irritation of the throat, as is frequently the case with an impure 
breath, gargle the throat with the wash. It will remove all odors, 
and, besides being curative, will impart a pleasant sense of cleanli- 
ness and purity. A thorough and systematic use of such a wash 
two or three times a day is an imperative necessity in the mouth of 
a person wearing bridge work, and should be used also by those 
wearing artificial teeth, to rinse both mouth and plate after cleans- 
ing them. It will insure a cleanliness that can be attained in no 
other way, and keep at the minimum the many little irritations 
of the delicate mucous membrane on which the artificial dentines 
rest. 



94 SANITATION. 

Salivary Calculus, or, as commonly termed, tartar, is com- 
posed of lime salts held in solution in the saliva and deposited upon 
the sides of the teeth, forcing back the gums, and causing their 
absorption, also the absorption of the bony walls of the sockets of 
the teeth. If allowed to remain it slowly increases, then causes 
inflammation of the gums and loosening of the teeth — a condition 
often erroneously called scurvy. Its cure is effected by a thorough 
and careful removal of all deposits, even though they reach below 
the gums, by a competent dentist, who will advise as to what local 
treatment, if any, should be applied to the gums. When you 
find any tartar collecting upon your teeth have it removed. 

In employing a dentist, be sure to retain a good one; do not 
let the main consideration be cheapness. Cheap dental work, like 
cheap work in everything else, is likely to be dear at any price, 
and you have but one set of permanent teeth. 

Although the teeth should be cleansed every morning, it is 
still more important to give them attention just before retiring 
at night. At both times first rub them and the gums on both 
sides of the teeth, with precipitated chalk, then follow with a 
good brush and rinse well. In case the sides of the teeth become 
tender discontinue the chalk a few days. He that cares for his 
teeth by simply brushing them on the front or outside does not 
live up to his privileges. 

During sickness the teeth are usually neglected. They should 
be kept clean, and if the patient is too ill to attend to them it 
must be done by the nurse, who should, with a piece of soft linen, 
clipped in the wash described above, clean them as well as she 
can, then have the patient rinse the mouth with the same kind of 
wash. It will be exceedingly grateful to the sick one. The 
decay of teeth during sickness is not as much due to strong medi- 
cines used, as to the altered condition of the fluids of the mouth at 
this time. A person under homeopathic treatment suffers as great 
injury to his teeth as the allopathic patient does. 

During the nine months of pregnancy the teeth decay more 
rapidly, and may become abnormally sensitive, causing great suf- 
fering. Much of this can be alleviated, in many cases entirely 
overcome, and the decay retarded in a marked degree, by the use 
of Phillips' Milk of Magnesia. The teeth should be cleansed 
night and morning with the mouth-wash described, after which a 
teaspoonful of the Magnesia is to be taken into the mouth and 



SANITATION. 95 

allowed to float around over the teeth. It will thus coat them with a 
film of magnesium hydrate, which is sufficiently adherent to 
protect them from acid action for a number of hours. The fluids 
of the mouth during pregnancy are nearly always acid, and it is 
probably due to this that the teeth are then so sensitive. After 
using the milk of magnesia do not rinse the mouth, but spit out 
any excess. This remedy will be found serviceable also in the 
vomiting of pregnancy, especially when acidity of the stomach 
exists. Dose : One teaspoonful as may be required. 

In jumping toothache from an exposed nerve, nothing will 
bring comfort sooner than strong carbolic acid placed directly on 
the nerve. This is best accomplished by placing loosely in the 
cavity a bit of cotton saturated with the acid, and covering it with 
a little dry cotton, beeswax, or other substance to keep the tongue 
from the acid. (The relief afforded is only temporary, but the 
application may be repeated as often as necessary until treatment 
can be obtained from the dentist.) Care must be taken not to get 
any of the acid on the gum, or other tissues, but in case of such an 
accident the burning may be stopped by touching the spot with 
glycerin or oil. Oil of cloves, laudanum, creosote, etc., are also 
often used for toothache. The following compound is excellent : 

Best alcohol one-half ounce. 

Chloroform one ounce. 

Sulph. ether three drams. 

Gum camphor two drams. 

Laudanum one-half dram. 

Oil of cloves one-fourth dram. 

Plug the tooth with cotton saturated with this cordial. The 
pain following extraction of a tooth can be relieved by pressing 
a pledget of cotton, thus saturated, well up into the socket and 
leaving it there an hour or two, and a little powdered tannin on the 
side of the pledget first entering the socket will prevent hemor- 
rhage. The most stubborn toothache of pregnancy may be re- 
lieved by bathing the tooth and gums with this preparation, then 
drawing in the breath a few times to pass the air over it. This 
is also an excellent application for swellings and bruises where 
the skin is not broken. 



CHAPTER VIII. 
STIMULANTS AND NARCOTICS. 

By Louis C. Duncan, M.D. 
ALCOHOL. 

The deleterious effects of alcohol have been so often and 
fully set forth, it would seem a superfluous work to write of them 
again. Every volume on medicine and every school book on 
physiology and hygiene tells of destruction, suffering and death 
wrought by alcohol. Societies make war upon it, lecturers de- 
nounce it and tracts emphasize its evils; but the disease and 
misery in evidence m every community prove that the lesson has 
not yet been learned, that its teaching must be continued, and 
the physiological effects of alcoholism, if possible, made still more 
clear and convincing. 

It is not our purpose to detail many of its most serious ef- 
fects. The moral degradation of the drinker, the deterioration of 
intellect, the crimes and accidents resulting from drink, the 
wretched poverty, the breaking up of families, the misery of wo- 
men, the suffering of children, and all the crime and debauchery 
following in the wake of alcohol we must leave to others. We 
have only to speak of its physiological effects, the diseased con- 
ditions produced by its action in the human body, though most 
will agree that harmful as these are, they are not more serious 
than its influence upon the intellect and morals of its victim. Al- 
cohol is indeed an enemy that steals away the brain, the keenness 
of perception, the accuracy of judgment, the power of continued 
thought and, above all, the fine distinctions between right and 
wrong that characterize the upright man. 

General Effects. — In sufficient quantity, alcohol at first pro- 
duces quickened action of the heart and lungs, a slight rise in tem- 
perature, an increased supply of blood to the brain and internal or- 
gans, increased muscular activity, and a general sense of well 
being; the senses are more acute, the imagination is stimulated, 
ideas come more readily; the face is flushed, the eyes bright and 

96 



SANITATION. 97 

the tongue loose. The speaker is more eloquent, but his judg- 
ment and reason are less sure. Following these effects the tem- 
perature falls to below normal, the muscles become unsteady, 
the tongue "thick," the gait staggering and speech incoherent. 
At this stage the drunkard may be very good natured and happy, 
or ill natured, morose and quarrelsome. Finally he can walk no 
longer, speech fails, and he passes into a stupor. The face is red 
and congested, the breathing slow and stertorous, the breath 
smells of alcohol and he can be only partially aroused. Such are 
the immediate effects of alcohol. After the debauch is over, the 
patient returns to his normal condition, not seriously damaged 
physically; but if one debauch follow another, or if he contract 
the habit of drinking a small amount each day, permanent and 
serious injury will certainly follow. It may be long delayed but it 
is sure to come. 

All experience in severe athletics, military campaigns, and 
North Pole and other expeditions involving fatigue, exposure and 
long tests of endurance, show that the total abstainer withstands 
these adverse conditions better than the toper, or even the mod- 
erate drinker. Lieut. Peary, in his inventory of supplies for his 
last trip toward the Pole, stated that no liquors were to be taken 
except those required by the surgeon, for not only are the highest 
achievements possible without the aid of liquors of any kind, but 
their continued use lowers the power of resistance, the vitality of 
the body, rendering it less able to endure fatigue, extremes of tem- 
perature and injury. It is well known by all surgeons that habitual 
drinkers do not bear anesthetics or stand surgical operations well, 
and that they are more seriously affected by injuries and all severe 
acute diseases. 

Let it not be supposed that the claims as to the evils caused 
by alcohol are figments of the mind, due to the excited imagina- 
tions of over anxious mothers, or too zealous temperance fanatics. 
Such eminent authorities as Drs. Revilliod and Sinet, Professors 
in the University of Geneva, Switzerland, as translated by Dr. Law, 
set forth their physiological effects as follows : 

"The morbid conditions brought about by alcoholism involve 
every organ and tissue of the body, and consequently distuib 
every one of its physiological functions, sometimes giving rise to 
special diseases characteristic of alcoholic poisoning, at others 
producing complications arising in the course of various maladies. 

7 



98 SANITATION. 

''The organs specially affected by alcohol, taken as a beverage, 
are, first of all, the stomach. After passing through the liver these 
alcoholic drinks, more or less modified, enter the general blood 
stream and circulate throughout every part of the body; but we 
wish here to specially refer to the kidneys, the heart, and the 
brain. The morbid alterations induced in these parts by the con- 
stant presence of alcohol in the tissues of which they are composed, 
though at first comparatively trifling and temporary, become per- 
manent and incurable sooner or later, according to the quantity of 
alcohol usually consumed and the duration of the drinking 
habit. 

"The accompanying plates show the various changes and 
diseased conditions of the organs referred to. They are repro- 
ductions from nature by experts in such subjects, viz. : (i). Dr. 
Lancereaux, Physician to the Hotel-Dieu in Paris, well known by 
his works on Alcoholism; (2). Professor Charcot, who illustrated 
his lectures on diseases of the liver and kidneys by a representation 
of the affections of the kidneys, in which excessive alcoholic in- 
dulgence played the chief part. These are the 'large white kid- 
ney' so named by Richard Bright, M. D., of Guy's Hospital; and 
the 'contracted kidney,' from a drawing by Dr. Gombault, Physi- 
cian to the Beaujon Hospital in Paris. These designs, executed 
by the experienced hand of M. Balicki, and here faithfully re- 
produced, show each organ as it would appear if actually before 
the eyes. Each plate exhibits for comparison the parts in their 
healthy, as well as in their diseased state. 

PLATE I. THE STOMACH. 

"Fig. I. Normal Stomach. — Laid open to show its internal 
surface lined by healthy mucous membrane. The organ, here 
represented moderately distended, varies much in size according to 
the amount of food contained, and the habits, as to eating and 
drinking, of the individual. The inner surface of the stomach, 
like that of the rest of the alimentary canal, consists of mucous 
membrane. This mucous lining is smooth, velvety, and moist, 
and varies in tint from pale rose to a reddish violet — as anyone 
may see for himself by looking at the mucous membrane of his 
mouth in a mirror. When not distended it lies in folds. The 
mucous membranes constitute the inner coating of most of the 
cavities of the body, they serve as a basis of support to the blood 




*w 



FIG. 1. 





.- 



...» 



k i 






Fig. 1. A Health)' Stomach. 

Figs. 2 and 3. Alcoholic Stomachs. 



SANITATION. 99 

vessels and nerves, and to the glands which secrete the gastric 
juice and the mucus which lubricates the lining membrane. 

"Figs. 2 and 3 represent Alcoholic Stomachs seen from their 
internal aspects. 

'Tig. 2. Stomach. — Laid open longitudinally to display 
its mucous lining on which are clearly shown the following le- 
sions : (a). Patches dotted with bright red, showing intense in- 
flammatory congestion, or slate colored, due to small extravasa- 
tions of blood of long standing. Here and there are noticed 
small rounded, or linear, ulcers which appear to follow the 
course of the blood vessels. Below, on the left, we may observe 
a large star-shaped scar showing the former existence of a vast 
ulcer, which has destroyed the mucous membrane and its sub- 
jacent layers at this place. This ulcer must have given rise, dur- 
ing life, to severe vomiting of blood. If its cause be not invariably 
found in alcoholic excess, its cure demands, none the less, com- 
plete abstinence from spirituous liquors. 

"Fig. 3. Stomach turned inside out like a glove to show its 
mucous lining. The latter, instead of being soft and velvety, as 
in the normal state, presents a papillated condition due to thick- 
ening of the mucous membrane and submucous glands. Towards 
the center is seen a large opaline white patch. The general tint, 
which, in the normal state, is uniformly roseate, is here, in some 
places slate colored, in others, light purple with black dots due 
to old extravasations of blood in the various layers of the coat. 

"One of the first deleterious effects produced by alcoholic 
abuse, and one experienced by all drinkers, is Mucous Catarrh. 
Upon waking in the morning the mouth is dry and clammy and 
there is oppressive thirst. Very soon, either upon first rising and 
moving about, or after gulping down liquid, the stomach contracts 
and expels a glain , ropy fluid sometimes mixed with bile. At a 
more advanced stage, when to simple catarrhal irritation, there 
has supervened inflammation of the organ with the serious lesions 
depicted in Plate I, Figs. 2 and 3, the digestive functions become 
deranged and are accompanied by eructations, vomiting, pain, and 
a sensation of burning at the pit of the stomach; the appetite is 
lost, diarrhea, sometimes alternating with constipation, occurs 
and the patient loses flesh. Y\ 'hen ulcerations have been pro- 
duced the taking of food is often followed by very severe pains; 
vomiting sometimes attains excessive frequency, the vomited mat- 



100 SANITATION. 

ter taking on a black tint from the presence of altered blood, or 
there may be actual hemorrhage. In such cases death may be 
speedy. 

PLATE II. THE LIVER. 

"Fig. I. Normal Liver. 

"Fig. 2. Enlarged Liver. 

"One can readily understand why this organ, which directly 
receives the liquids absorbed from the stomach, should be the first 
to be injured when these liquids, by their quality, are of such a 
nature as to alter the substance of the organs they pass through. 
Alcohol, which is of that number, produces eventually an increase 
of each of the, anatomical elements of which the liver is com- 
posed, and consequently of its entire bulk. By and by, this pro- 
cess specially affects the bile ducts, causing increase in their num- 
ber and size, and ending by obstructing them. A work of disor- 
ganization results, which invades the substance of the organ, and, 
of course, perverts its functions. This variety seems to us to 
specially pertain to excessive drinkers of beer and white wine. 

"Fig. 3. This is the small contracted liver — atrophic cirrho- 
sis — a variety which may be called characteristic of that organ in 
alcohol drinkers. In England, it is known as gin drinker's 
liver. In this variety, the liver, which must at first have under- 
gone a stage of enlargement, is now, so to speak, reversing the 
process. It shrinks progressively, becoming more and more con- 
tracted within an enveloping membrane, which sends fibrous 
prolongations into the substance of the liver, choking vith a 
scar-like tissue the proper secreting elements of the gland. Al- 
coholic cirrhosis, or hardening of the liver, is one of the most 
frequent diseases of drunkards. After a longer or shorter period 
of digestive troubles, the disease is characterized by effusion of 
fluid into the cavity of the abdomen, caused by the difficulty of 
carrying on the circulation through the hard shrunken liver. The 
belly becomes enormous, and by its size contrasts with the general 
emaciation of the individual; while upon its surface the subcu- 
taneous veins, engorged with blood, testify to the obstacles placed 
in the way of circulation. If, to relieve the patient, we draw off 
by an operation, the fluid from the belly, it may amount to 
twenty-five, or even thirty-five, pints. The relief thus obtained 
is only temporary; the fluid is usually re-formed very shortly. 
Hemorrhages are frequent. There is often bleeding of the nose; 




FIG 1 






... 











^<2>^ 




PLATE II. 



Fig. 1. Healthy Liver. FiCx. 2. An Enlarged Liver. 

Fig. ?>. A Contracted or "Gin Drinkers" Liver. 



FIG. 2 



SANITATION. 101 

at other times, spitting or vomiting of blood. There is seldom 
true jaundice, but the skin assumes an earthen tint, the patient 
emaciates more and more, and death seldom fails to supervene 
within one or two years, and often indeed much sooner. Cure is 
altogether exceptional. 

PLATE III. THE HEART AND KIDNEYS. 

''Fig. I. The Normal Heart. 

"Fig. 2. The Heart completely enveloped by fat. — This adi- 
pose layer is able to penetrate also into the substance of the heart, 
separating the bundles of muscular fibers which often themselves 
become the seat of fatty degeneration. Alcoholism is a frequent 
cause of this lesion, which leads to death by the disturbance pro- 
duced in a function so important as that of the central organ of 
the circulation. 

"Fig. 3. The Normal Kidney. — The kidneys act in cleansing 
the organism. The circulation here is very active, and carries to 
them all the substances in the blood which, because they are either 
wastes, superfluous, useless, or noxious, have to be eliminated. 
But the texture of these organs is very delicate, and is easily altered 
if the blood conveys to them an irritant substance, such as alcohol. 

"Although the alcohol has undergone a partial chemical trans- 
formation in the organism before reaching the kidneys, it never- 
theless retains, where taken in large quantity, its noxious effect 
upon the blood vessels of the kidneys, and the uriniferous tubules. 
We recognize here, as in the liver — Fig. 4 — an enlarged kidney, 
'the large white kidney,' and — Fig. 5 — a small, contracted or 
atrophied kidney. These are different forms from an anatomical 
point of view but they may be combined in the same individual. 

"Besides the lesion of the heart mentioned above, alcohol pro- 
duces circulatory troubles, and alterations in the vessels which re- 
act in an injurious manner on all the organs. The diseases of 
the kidneys represented in Plate III, Figs. 4 and 5, are, unfor- 
tunately, very often observed under the influence of numerous 
causes independently of any alcoholic excess; but they are also 
frequently the consequence of abuse of alcoholic beverages. We 
may well ask whether the great frequency of these diseases at the 
present day, is not accounted for in a certain measure, quite apart 
from actual drunkenness, by the long continued and somewhat 
too free indulgence in habits of drinking. The kidneys thus 



102 SANITATION. 

affected, on the one hand, permit the albumen of the blood to pass 
away in the urine — albuminuria — which constitutes a loss to the 
organism ; on the other hand, they do not fulfill their cleansing of- 
fice, and the dangerous substances, which they are charged with 
the duty of eliminating, gradually accumulate in the blood. This 
gives rise to a series of symptoms of poisoning, often fatal, known 
by the term uremia. These sometimes take the form of con- 
vulsive seizures, at others of loss of consciousness ; often, also they 
are shown by an extremely distressing feeling of suffocation, by 
violent headaches, or by repeated vomiting. The circulation is 
frequently deranged during the course of kidney disease. It may 
then give rise to effusion of fluid into the serous cavities, and the 
subcutaneous cellular tissue — a state well known under the name 
of dropsy. 

PLATE IV. THE BRAIN. 

"Fig. i. Normal Brain with its coverings (Membranes). 

"Fig. 2. Alcoholic Meningitis. 

"We are too well acquainted with some of the disorders of 
the nervous system which may result from excessive drinking. It 
is not necessary that functional derangement should always be ac- 
companied by permanent lesions that can be recognized in the 
brain after death. It may even happen that a fatal termination 
may occur without the disease having left behind any material 
trace during its course. On the other hand, the complex con- 
ditions which interfere with the daily existence of' the drunkard, 
the bruises, '-brain joltings, etc., form a large proportion of the 
lesions we are able to find after death. Nevertheless, as has been 
stated by Dr. Lancereaux, there exists an alteration peculiar to 
alcohol which specially affects the membranes of the convexity of 
the brain. These, which in the healthy state are thin, delicate, 
and transparent, become thickened, opalescent or opaque, and 
scattered throughout with minute patches and small whitish eleva- 
tions (Fig. 2). In the acute stage, in case of death, during an at- 
tack of delirium tremens, we may find, moreover, an intense vascu- 
lar injection, which imparts to the convex surface of the brain a 
bright rosy tint. Blood may even be extravasated upon the sur- 
face. These lesions affect those membranes most closely applied 
to the brain. The dura mater, the outermost covering, a thick 
white membrane which lines the internal surface of the skull, may 
also, under the influence of chronic alcoholism, become vasculai- 




FIG. 1. 




FIG 2 





FIG. 5 




r 



FIG. 3. 



FIG. 4. 





PLATE III. 

Fig. 1. A Healthy Heart. Fig. 3. A Healthy Kidney. 

Fig. 2. An Alcoholic Heart. Fig. 4. An Enlarged Kidney. 

Fig. 5. A Contracted Kidney. 



SANITATION. 103 

ized, and give rise to repeated hemorrhages forming layers of 
blood clot, which by their thickness exercise a gradually increas- 
ing compression of the surface of the brain. The latter, in its 
turn, may participate in the inflammatory trouble, when various 
disturbances of the nervous system may result, such as weakness 
and perversion of motion and sensation, enfeeblement of the 
intellectual faculties, madness, and all the symptoms of an ad- 
vanced form of general paralysis. 

'The nervous disturbances produced by alcohol are very 
numerous. First, there are the acute phenomena characterized 
by excitement of the nervous system, constituting inebriety or 
drunkenness. In an extreme case, this ends in coma; that is to 
say, complete loss of consciousness and muscular power. This 
condition, the result of heavy drinking, sometimes terminates in 
death. Among the more chronic manifestations are to be noted 
trembling, which often impedes delicate manual operations, dis- 
turbances of sensation, perversions of the organs of the senses, 
enfeeblement of intelligence and memory, bad dreams, etc. At- 
tacks of delirium may supervene with fever and terrifying halluci- 
nations, general trembling, and brutish impulses. These attacks 
are known under the name of delirium tremens. Abuse of alco- 
holic liquors sometimes produces also weakness of sight, the result 
of an inflammation of the nerves which place the eyes in communi- 
cation with the brain (optic nerves). The dimness of vision is 
specially pronounced in looking at small objects or doing close 
work, such as reading, writing, or line mechanical work. Occa- 
sionally the patient is unable to distinguish colors. This affection 
of the optic nerves is quite comparable with the paralysis of the 
nerves of the limbs, which is sometimes observed in alcoholic sub- 
jects. It rarely proceeds to blindness, but it may cause more or 
less complete incapacity for work. 

"The lesions, which are shown in Plate IV, at first affect the 
membranes and lead either to mental alienation or to convulsive or 
apoplectiform seizures, which often prove fatal. 

"Lastly, it is important to draw attention to the injurious 
influence which alcoholism in parents exercises over the nervous 
systems of their offspring, who are born to the sorrowful heritage 
of a predisposition to insanity and mental degradation.'' 

Alcoholism is recognized as one of the direct causes also of 
epilepsy, a disease which is not only practically incurable, but fre- 



104 SANITATION. 

quently leads to insanity, and is likely to be stamped upon the 
children of the drunkard in the form of consumption, epilepsy, 
feeble-mindedness, insanity or idiocy. 

TOBACCO. 

So much had been said for as well as against tobacco, many 
had come to believe that any treatment of the subject would result 
only in an assertion of the preconceived opinion of the investigator, 
and that while the tobacco habit was injurious to some, to a much 
larger class it did no harm; but in later years, as more scientific 
methods of inquiry have been employed, and its effects upon in- 
dividuals have been grouped together in classes sufficiently large 
to secure reliable averages, indisputable and startling facts have 
been discovered. 

The composition of the dried tobacco leaf has long been 
known. Besides starch and various acids and salts, its two essential 
elements are nicotine and nicotianine. The former, a colorless 
liquid alkaloid with an odor of tobacco and a sharp burning, taste, 
turns to a dark brown and dries to a resinous gum on exposure to 
the air, and is one of the most virulent poisons known — a single 
drop of it being sufficient to kill a dog. The latter is an oil, and 
scarcely less poisonous than the nicotine, which it resembles in 
odor and taste. In mode of action both are much like Prussic 
acid, and almost as deadly, and both have narcotic properties, the 
principal qualities which give tobacco fascination for its dev- 
otees, but the alkaloid has properties distinct from those of the 
oil, and each is said to act differently from the other upon the 
various vital organs, of the body. Thus, the smoker, who gets less 
of the alkaloid but more of the oil than the chewer, is affected in 
ways quite different from those experienced by the latter, yet it 
may be impossible to say that the one is injured less than the other. 

The proportion of nicotine in Havana dried leaf is usually 
from one to two per cent, but in many varieties grown in Northern 
States it is seven or eight per cent. Burning tobacco does not 
destroy its nicotine ; as high as 84 per cent of it has been recovered 
from the smoke. Hence, from each ounce of strong tobacco used, 
making liberal deductions for all possible waste, the smoker draws 
into his mouth several grains of the deadliest poisons known. 
That they do not kill him instantly is largely due to his blowing 
them nearly all out again, but a good deal of the portions which 



> 

P, 

bd 

3 





SANITATION. 105 

come in contact with the moist membranes is quickly absorbed, 
as shown by the headache, dizziness, deathly pallor, distorted fea- 
tures, feeble pulse, labored breathing, faintness, salivation, and 
often by the vomiting and violent abdominal pain, of those just 
learning the art. After repeated protests the system comes to 
tolerate it because the nerves involved become so dulled or dead- 
ened as no longer to be able to resist. 

Having reached the tolerant stage many appear to be able 
to use tobacco without any ill effects, but the proportion of those 
who can really do so is much smaller than is generally supposed. 
Of this a proof was furnished on a large scale at the breaking out of 
war with Spain, in the great number of would-be-volunteers re- 
jected because of heart disorders, due in most cases to smoking. 
It is claimed that oo per cent of the cigarette smokers offering 
themselves were unfit for military service for this reason. Indeed, 
so frequently have heart troubles been traced to this cause, it has 
become a common statement that what alcohol is to the brain 
tobacco is to the heart, an assertion partly true, but misleading if 
understood to mean that the brain is not also injured. The pecu- 
liar action of nicotine upon the heart is explained by physiologists 
as due to its special influence upon the vagus, the great nerve of 
that organ, paralyzing its activity, thus 'leaving the uncontrolled 
heart muscle to wear itself out." 

The lungs also suffer from tobacco. The constantly in- 
creasing mortality in the French army is charged to pulmonary 
diseases favored by cigarette smoking, for while other presumable 
causes are no more active now than formerly, this one during the 
last few years has been steadily growing. The specially serious 
effects of the cigarette are no longer charged to adulterations of 
the tobacco, or of its wrapper, but to the facility cigarette smoking 
affords for excessive indulgence; to the common practice of in- 
haling its smoke, when of mild tobacco, thus adding the entire 
inner surface of the lungs to the poison-absorbing area; and 
to the completeness with which the end held in the lips is burned, 
a result being thus obtained similar to that experienced by a 
cigar smoker, who partly smokes, partly chews his cigar, thus get- 
ting all the poison which the stub had filtered from the smoke ; 
or by the excessive smoker of a dirty cutty. Like opium it quiets 
the nerves for a time, but becomes an irritant later. 

To afford an opportunity for the study of tobacco effects upon 



106 SANITATION. . 

the brain, the students in a polytechnic school in Paris were some 
years ago divided into two classes, smokers and non-smokers. In 
the averages of work done, and in the competitive examinations, 
during the four years' course, those who did not smoke far out- 
stripped the others. 

More recently, a somewhat similar comparison between users 
and non-users was made at Yale, and some of the results of four 
years of careful observation were as follows : 

Increase in height 20 per cent greater in non-users. 

" weight 25 " 

" lung capacity ...66 

Inflated chest measurements 19 

Although 30 pei cent of the class used tobacco, all its promi- 
nent athletes, with but one exception, were non-users, and none 
of the candidates for the crew used it. 

At Amherst a similar study disclosed even greater differences. 
They were as follows: 

Increase in height 37 per cent greater in non-users 

" weight 24 

" " chest girth 43 " " " 

" " lung capacity 75 " 

Upon these facts the director of the physical laboratory of 
Yale remarks: "The widely differing growths in lung capacity 
point to the influence of tobacco on respiration. Inspiration is 
essentially a muscular act, and as such is seriously impeded by 
nicotine. But even further than this must act the irritating sub- 
stances of a smoke which readily causes inflammation and soreness 
of any mucous membrane. Now, to fully expand the lungs under 
such conditions is uncomfortable, if not impossible, and respiration 
degenerates into an incomplete act." 

Very strong testimony, too, as to the injurious effects of to- 
bacco poisons on the brain, and consequent depression of mental 
activity, is found in the records of Yale which show that of all the 
students who entered that college during a period of nine years 
the average age of non-users was fifteen months less than that of 
the users of tobacco. 

Amaurosis, a form of partial or total blindness resulting from 
disease of the optic nerve, may primarily be due to so many differ- 
ent things that it is often hard to point to the cause, but Hutchin- 
son found that in $7 cases of amaurosis from white atrophy of the 



SANITATION. 107 

optic nerve, 31 of them occured in immoderate smokers. Tobacco 
is positively known to be the cause in many cases, and as its irri- 
tating effects upon the nervous tissues are no longer questioned 
the smoker whose sight is failing rapidly may well suspect his 
habit. Indeed, by an examination of the eye, the results of the 
prolonged use of tobacco can often be cleariy seen in the optic 
disc — the end of the optic nerve, the only large nerve accessible 
to ocular observation. 

Although the processes employed in the manufacture of snuff 
render it less poisonous than the tobacco of which it is made, its use 
seems to cause a profound depression not only of all the bodily 
senses, but, to an even greater degree, of the higher mental quali- 
ties, as often seen in loss of pride in character and appearance, 
diminished ambition, disregard of surroundings and indifference 
to the opinions of others; with continuance of the habit delusions 
may appear, a low form of dementia or melancholia follow, and 
death come from some acute disease to which the condition pre- 
disposes. 

It is not well enough understood, even by intelligent people, 
that tobacco is rich in insidious poisons, often cumulative in action, 
and deadly in result, Although formerly used as a medicine, it 
is now almost entirely discarded because too dangerous, either to 
be given internally, or applied to the skin. Among the disorders 
of which it may be an exciting cause are indigestion, dyspepsia, 
cancerous affections of the tongue and throat, congestion of the 
brain, loss of memory, nervousness, deafness, paralysis, insanity, 
emasculation, loss of courage, and lessened power of resistance 
to disease. 

Treatment. — By far the best, if not the only treatment 
for the tobacco habit is to abruptly and entirely quit, then through 
the aid of Turkish baths, vapor baths, wet packs, or any other de- 
vice for causing profuse perspiration, get the accumulated poisons 
out of the system as quickly as possible. Place no dependence 
upon substitutes, or any of the so-called cures, but assert your 
will-force and mastery over self. Let tobacco entirely alone and 
keep away from those who use it, and in ten days or less the 
appetite for it will be nearly or entirely gone. 

In the government schools of this country and those of some 
European countries, where the directors, unhampered by con- 
siderations of income from tuition, are free to manage pupils in 



108 SANITATION. 

the most scientific manner for their highest good, the use of to- 
bacco is forbidden, and the same advanced step is being taken 
in many private schools. As the habit has grown to such pro- 
portions that the people of the United States are spending about 
as much for tobacco as for flour, the time has certainly arrived 
when its use should be prohibited in all our schools. 

MORPHIOMANIA. 

Opium, is obtained from the juice of green poppy-buds, is a 
very complex substance possessing many properties, and, for 
numerous diseases, is an excellent medicine, both for allaying 
pain and promoting a cure, but no other drug is more sadly per- 
verted. Opium smokers and opium eaters are found throughout 
the world, though the practice is by far the most prevalent in the 
orient, especially in China, where it has become so general as to be 
a national calamity. To obtain the temporary ease and delight 
which give the vice its charm the victim must continuously in- 
crease the dose until, in a few years, it becomes many times larger 
than that required to cause certain death in one unaccustomed 
to its use. But, finally, a time arrives when in any amount it fails 
to bring the desired relief, and the patient is reduced to a condition 
of physical and moral degradation wretched in the extreme. 
When thoroughly formed the habit is seldom cured, for so great is 
the irritation, unrest, pain and suffering, from physical derange- 
ment and mental depression, whenever the drug is even partially 
withdrawn, that very few have the stamina to quit. 

The same is true of slaves to morphine, opium's most power- 
ful alkaloid. It is a valuable remedy for many diseases, but so 
great is the danger of its creating a morbid desire that cannot be 
shaken off, it should be employed with the utmost caution and, 
except in very urgent cases, administered hypodermically only by 
a physician. Six months is often long enough to establish the 
habit so firmly as never to be broken, except by the most deter- 
mined. The duration of a ''morphine fiend's" career is one of 
constitutional peculiarity only; his ultimate physical, mental and 
moral ruin is sure. 

Morphinism and alcoholism are in many respects alike, but in 
development they are different. Alcohol first attacks the diges- 
tive organs, then destroys the nervous system ; morphine reverses 
this order. 



SANITATION. 109 

Since the victim can hardly fail to be aware of the cause of 
his ills, and the habit can be treated successfully only in a sanita- 
rium, or other institution specially equipped, space will not here be 
given to listing the disorders to which it gives birth, nor to detail- 
ing the steps essential to the cure. It will require the services of a 
physician and nurses most vigilant and faithful, and such long and 
thorough treatment as to fully destroy the appetite, for, otherwise, 
the patient will return to his indulgence when freed from re- 
straint. 



CHAPTER IX. 
DISINFECTION AND DISINFECTANTS. 

By Joseph T. Lovewell, Ph.D. 

The object of disinfection is to remove or destroy that which 
will cause disease. 

It is now well established that most forms of disease are 
caused by germs, or at least are associated with germs which live 
and multiply in the body, poisoning its blood and interfering gen- 
erally with the functions of its organs. These microscopic forms 
of life occupy a borderland between animals and plants, and it was 
long difficult or impossible to determine to which they belonged. 
We call them microbes, small forms of life, a term applying equally 
to both kingdoms ; animalcula and bacteria are names also often 
applied to them. 

It must not be understood that all microbes are harmful to 
human life. They have their place in the economy of nature, and 
stand at the gateway where inorganic matter becomes organic, 
or where the process is reversed and the organized structure 
breaks down into simple elements or combinations, into which 
what we call animal life does not enter. 

The great French chemist and physicist, Pasteur, has shown 
that all forms of fermentation are caused by bacteria, or little 
plants of which yeast is a most familiar example. Keep these 
germs out and fermentation does not ensue, and so we seal up our 
meats, fruits and vegetables, and preserve them from decay. Sim- 
ilar germs are associated with mold and fungus growths, and with 
everything known as putrefaction — the general breaking up of or- 
ganic structures. The final products of this decay are principally 
carbonic acid and water, for all the protean forms of the organic 
world are built up from a very few elements of which carbon, hy- 
drogen and oxygen are chief. As the processes of decay run their^ 
course the elements which enter in smaller proportions, such as 
sulphur and nitrogen, often form a great variety of intermediate 
products, some of which have very offensive odors and warn us 
against touch and taste. 

no 



SANITATION. Ill 

On the other hand when elements are to be combined into 
organic matter, the work of the microbe is also utilized and is 
essential. For example, take nitrogen, which is needed as a 
constituent of many forms of animal and plant life ; this element 
forms four-fifths of the atmosphere but will not enter into organic 
combinations until it has undergone nitrification — a combination 
with oxygen and hydrogen — and it is believed that this combina- 
tion is always effected through the agency of microbes. It is not 
necessary to give here a full account of microscopic beings, nor is 
it possible, for bacteriology is comparatively a new science and its 
researches have extended but a little way. It is sufficient to be 
reminded of the mighty hosts which surround us, ready either to 
succor or to destroy. They will, sooner or later, bring our bodies 
back to the dust from which they came, but we prefer to run the full 
course of life and not to suffer a premature decay. Of the various 
diseases, such as small-pox, cholera, the yellow, typhoid, scarlet 
and malarial fevers, consumption, measles and diphtheria, which 
kill a large part of the human race, each one is caused by a microbe 
of special kind suited to its work. It is positively known that by 
proper agencies these microbes can be destroyed or danger from 
them in a large degree averted. 

WHEN TO APPLY DISINFECTANTS. 

The presence in any locality of a germ disease proves at once 
the need of disinfection, both to prevent the spread of the disease 
and to mitigate its effects. The first case of yellow fever, for 
example, is usually light and, as in this country the disease is not 
endemic, it is comparatively easy by isolation and disinfection to 
prevent it from spreading. The same is usually true of other in- 
fectious as well as contagious diseases. Hence the importance of 
prompt disinfectant measures. It is also proper to disinfect be- 
fore any disease appears, provided the season, or the condition of 
the locality in respect to drainage, cleanliness, or proximity to in- 
fected places makes the precaution a prudent one. 

PRINCIPLES OF DISINFECTION. 

In the destruction of all forms of disease germs certain general 
principles apply: The first is the principle of dilution, nature's 
great remedy whereby the world is kept habitable for man. This 
is effected by movements of air and water, through which all 



112 SANITATION. 

poisons lose their virulence and the death dealing microbe perishes 
from lack of that on which to feed. 

Second. There is disinfection by changes in temperature. 
Some germs, as those of yellow fever, are killed by frost ; others, 
and perhaps all, are rendered inert by freezing, but many of them 
become active again when the temperature is raised. It is obvious 
that on a large' scale, low temperature is a matter of climate and 
that man sooner than microbes will succumb when deprived of heat. 
In cold storage we make a limited use of this principle in arresting 
decay. On the other hand when the temperature is raised we 
soon reach a point destructive to all forms of life with which we are 
acquainted: It is safe to say that no germ or living organism 
can long withstand the temperature of boiling water. There is 
large use made of this principle in disinfection. Garments and 
utensils which can be soaked in boiling water for half an hour 
will thereby be thoroughly disinfected, and hot steam is a most 
excellent agency for disinfecting rooms and cars. 

Dry heat will disinfect, but it is generally less conveniently 
applied than hot water or steam and is so untrustworthy that it 
is now very little used. The extreme heat of combustion is re- 
sorted to when we are willing to sacrifice the infected articles in 
order to destroy the disease germs they contain. This is the 
common disposition of rubbish, and pest houses, with their in- 
fected furniture and clothing, are frequently best committed to the 
flames. The burning of old buildings in cities is often of enough 
sanitary advantage to pay for the simultaneous destruction of 
structures new and without fault. Cremation of the dead, for the 
sake of good sanitation, is supported by arguments that ought to 
find general acceptance. 

Direct sunlight is a powerful disinfecting agency. The 
actinic rays are potent in effecting chemical action, and exposure 
to sun and air is often all that is needed to disinfect bedding, cloth- 
ing and furniture ; but mattresses, comforts and thick clothing are 
liable to become infected to a depth to which sunlight cannot pene- 
trate, hence too much confidence must not be placed in this 

method. 

CHEMICAL DISINFECTANTS. 

We next consider the disinfectants of more special application. 
Many substances have been proposed as germicides and it should 
be remembered that they are all poisons, generally as destructive 



SANITATION. 113 

to human as to germ life. A disinfectant may be in the solid, liquid 
or gaseous form, and that form should be chosen which is best 
adapted to the end in view. Then, too, there are deodorizers 
which may or may not be disinfectants ; they act by forming with 
the odoriferous principle a substance which is odorless, or they de- 
stroy the odor by another which is more pungent. The latter 
class may be positive obstacles to the ends in view, for the sense of 
smell tells us what to avoid, and if this sense be cheated or over- 
powered we will lose a most important guard of health and safety. 

Carbolic Acid is slow in its action but when it can have plenty 
of time is one of the most useful disinfectants. It is used in solu- 
tions, and their activity can be increased both by adding common 
salt and by using them hot. It is a deadly poison if swallowed, 
and it should not be applied extensively to the human body. If 
dissolved in alcohol, oil or glycerin, it loses most of its disinfecting 
power. 

Crude Carbolic Acid is only slightly soluble in water, but 
hot water containing three per cent of soap dissolves five per cent 
of crude carbolic acid, and in this form is a valuable disinfectant. 

Crcsol. — The cresols are obtained from crude carbolic acid by 
distillation, and are only slightly soluble in pure water but, by 
adding neutral potash soap, water can be made to dissolve one- 
half its volume of cresol, thus forming lysol, which by the addition 
of water can be reduced to any strength desired, and for disin- 
fecting purposes is preferable to carbolic acid solutions for the 
following reasons : It is cheaper, it is not quite as poisonous, and 
is better for disinfecting excreta and tuberculous sputa. It is 
excellent for washing floors and woodwork, and for disinfecting 
linen and cotton clothing soaked in it, but it is likely to injure the 
colors and the fabrics themselves. 

Solutol is obtained by dissoh ing sixty per cent oi cresol in 
water to which an alkali has been added. It is cheap, effective and 
well adapted to disinfecting large quantities of organic matter. 
For general use a half pint of the solution may be mixed with 
two or three gallons of water. 

Tricresol and Creolin are other solutions of the cresols and, 
although less valuable than lysol and solutol, form the bulk of 
several patented compounds sold under high sounding names. 

Corrosive Sublimate (bichloride of mercury) under favorable 
conditions is a quick and powerful disinfectant, but as it coagulates 



114 SANITATION.' 

albumen, and is decomposed by hydrogen sulphide 'and several 
other things, it is not adapted to disinfecting sputa or excreta. Its 
solutions must be prepared and kept in glass or earthenware, they 
will destroy metallic waste pipes, and they are very poisonous. It 
is excellent when used as a wash upon walls,' floors, woodwork, 
furniture, upholstery and clothing ; it is also a good disinfectant for 
the hands, face, hair and beard, but it should not be applied to a 
very large portion of the body at one time. It does not often 
injure the colors of fabrics and does the fabrics themselves no 
harm. 

Lime. — When freshly slacked and diluted with water until 
it reaches the consistency of thin cream, lime is a good disinfectant 
for excreta, but it is slow and must be used in large quantities- 
Applied as whitewash it is good to disinfect walls. Air slacked 
lime has no value as a disinfectant. 

Chloride of Lime. — This is one of the best disinfectants and 
may be used for the same purposes as lime, but to be trustworthy 
it should come from a reliable manufacturer, be kept in air-tight 
cans, the solutions be freshly prepared when used, and used in 
larger quantity than the bulk of the material to be disinfected. 

Soap and Soda. — Hot soapsuds, and solutions of washing soda 
have some value as disinfectants. Hot lye, made from one part of 
fresh hardwood ashes and two parts of water, will effectually 
disinfect tuberculous sputa and discharges from the bowels. 

Permanganate of potash, sulphate of copper (blue vitriol), 
sulphate of iron (copperas), sulphate of zinc, and chloride of zinc 
were formerly much used as disinfectants, but they are now known 
to have little disinfecting value and some of them are almost 
worthless. 

Chlorine and bromine gases are efficient disinfectants for 
some purposes, but are very injurious to articles subjected to them 
and too disagreeable and dangerous to be recommended. 

Sulphur. — Sulphur dioxide, made by burning sulphur at the 
rate of four pounds for every 1,000 cubic feet, with allowance for 
waste, is one of the agents longest in use for the fumigation of 
rooms. All doors, windows, flues and crevices must be tightly 
closed and the fumes allowed to act for at least twenty-four hours 
and abundant moisture, best as steam, must be present at the same 
time. Sulphur fumes are very poisonous, are injurious to many 
articles of furniture, are not very reliable as a disinfectant for 



SANITATION. 115 

diphtheria and some other diseases, and the results are not as 
trustworthy as they ought to be. 

"Formaldehyde. — A new substitute, safer and more efficient 
than chlorine, bromine or sulphur, chemically known as formalde- 
hyde (CH 2 O), has lately come into general use. It is usually 
prepared by burning wood alcohol (methyl alcohol) in a lamp de- 
signed for the purpose and so arranged that the flame comes in 
contact with red hot platinum, by which treatment the alcohol 
loses the elements of water and formaldehyde is the result — a gas 
oT very peculiar and penetrating odor, but not as offensive or 
poisonous to man as sulphur fumes, and much more conveniently 
managed. When formaldehyde lamps are used, one and a half 
pints of wood alcohol to each 1,000 cubic feet should be changed 
into formaldehyde in one and a half hours. The room must be 
kept very tightly closed while the gas is being applied, all cracks, 
flues and openings having been thoroughly calked. Eight hours, 
one-third of the time required for sulphur dioxide, is sufficient to 
disinfect with formaldehyde and the result is more certain. 

Formaldehyde may be dissolved in water, and a forty per cent 
solution of it is called formalin. By boiling formalin the formalde- 
hyde is again set free, and this is generally the most convenient way 
of getting the gas, as well as the most reliable, since the lamps 
often fail to do their work. It can be passed into a room by a 
tube through a small aperture, as a keyhole, and thus very safely 
and quickly four per cent of the atmosphere within is changed to 
formaldehyde. One gallon of a forty per cent solution of formal- 
dehyde will yield fifty cubic feet of the gas, an amount sufficient 
for a room of 1,250 cubic feet. If there is a probability of infec- 
tious sputum being dried upon the walls, floor or furniture, as 
often happens in cases of diphtheria, consumption, scarlet fever, 
and the like, the surfaces should be washed or sprayed with for- 
malin diluted (Solution 7) before the gas is turned in. 

DISINFECTING SOLUTIONS. 

For these formulae and details as to their application, together with 
other material used in the preparation of this department, we are indebted 
to investigations by the State Board of Health of Maine. 

Solution 1. For clothing, woodwork, floors, leather, excreta 
in the sick-room, sputa, the hands, the person. 

Solution 2. For the same general uses as Solution 1. It is 



116 SANITATION. 

a little more efficient than Solution i : but more likely to injure 
colors. 

Solution j. For tuberculous sputum, and discharges in the 
sick-room. 

Solution 4. For excreta, privy vaults, cesspools, etc. 

Solution 5. For the same purposes as Solution 4. 

Solution 6. For clothing, the hands, and the surfaces of 

walls, floors, furniture, etc. 

Solution 7. For clothing, the hands, etc. 

SOLUTION 1. 

Carbolic acid (pure liquefied), seven ounces; 

Water, one gallon. 

Mix. This is approximately a five per cent solution. Its 
power is somewhat increased by the addition of from twelve to 
fourteen ounces of common salt to each gallon when used for the 
disinfection of excreta, or for other uses where the salt is not objec- 
tionable. (See "Carbolic Acid.") 

SOLUTION 2. 

For the disinfection of clothing this solution mixed half and 
half with water will do. 

Lysol, five ounces ; 

Water, one gallon. 

Mix. This may be used as a substitute for Solution 1, one- 
half the strength sufficing for uncolored clothing. Many colors 

are changed by it. 

SOLUTION 3. 

Solutol (crude or pure), one-half pint; 

Water, two or three gallons. . 

Mix. This is a very efficient disinfectant for excreta, tuber- 
culous sputum, and gross disinfection generally. If to be used 
in dwelling houses or wherever the odor of the crude product 
would be offensive, pure solutol should be applied. 

SOLUTION 4. 

Chloride of lime, six ounces ; 
Water, one gallon. 

Mix. This is about a three per cent solution. It decolor- 
izes and destroys fabrics. 



SANITATION. 117 

SOLUTION 5. "Milk of Lime." 

Slake a quart of freshly burned lime in small pieces with 
three-fourths of a quart of water — or, to be exact, 60 parts of 
water by weight, with 100 of lime. A dry powder of slaked lime 
(hydrate of lime) results. Make milk of lime not long before it 
is to be used, by mixing one quart of this dry hydrate of lime 
with four quarts of water. 

Air-slaked lime is worthless. The dry hydrate may be pre- 
served for some time if it is inclosed in an air-tight container. 
Milk of lime should be freshly prepared, but may be kept a few 
days if closely stoppered. 

SOLUTION 6. 

Corrosive sublimate, one dram ; 

Water, one gallon. 

Mix and dissolve. Label, "Poison!" This is approximately 
a 1 to 1,000 solution. One ounce of this solution contains very 
nearly half a grain of corrosive sublimate. 

SOLUTION 7. 

Solution of formaldehyde (formalin), six ounces: 
Water, one gallon. 

Mix. This mixture contains a little less than two per cent 
of formaldehyde. 

WHAT DISINFECTANTS TO USE AND HOW TO USE THEM. 

The disinfection of infected rooms and their contents cannot 
usually be well done with a single disinfecting agent or disinfecting 
process. Special disinfectants and special processes must be em- 
ployed for special purposes. Thorough work, however, may be 
done even when the means at one's disposal are but few and 
simple, but the expense involved in washing paper from the 
walls of an infected room will often be more than the cost of 
an apparatus for using formaldehyde. In disinfection it should 
be remembered that success is influenced by : 

/. Temperature. Disinfecting solutions generally act more effi- 
ciently when used warm or hot. A somewhat elevated tempera- 
ture in the room increases also the activity of formaldehyde when 
used for its disinfection. 

2. Time. This is an important element in disinfection. In 



118 SANITATION. 

treating discharges in the sick-room, or tuberculous sputum, for 
instance, disinfectants should act several hours. 

j. Quantity. The volume of the disinfectant used, as com- 
pared with that of the infectious material, is often much too small. 
Care should be taken to use enough. 

To Protect Houses. — At the beginning and during the whole 
course of a case of an infectious disease, the family and the 
attendants on the sick should be under instructions, that as 
small a part of the house as possible shall become infected. 
Everything not absolutely needed in the sick-room should be 
removed from it before the patient is carried into it, or before 
they become infected. This applies particularly to carpets, drap- 
eries, upholstered furniture, and other things disinfected with 
difficulty. All the patient's bed and personal clothing should be 
disinfected as soon as it is removed. Every other article carried 
from the infected room should be disinfected then and there. 

Rooms. In the disinfection of rooms it should be kept in 
mind that the chief task is the destruction of infectious dust. At 
every movement be on guard against the danger of whisking it 
into the air or diffusing it into other rooms. Before the disin- 
fection of the rooms themselves is begun, there should be a pri- 
mary sorting out. Some things, as the clothing and some or all 
of the bedding, should be removed for separate or special treat- 
ment. (See "Clothing," "Bedding," etc.) 

In the disinfection of rooms formaldehyde is by far the most 
convenient agent. Properly used it can be trusted to disinfect 
the exposed surfaces of walls, floors, furniture, etc., and the infec- 
tious dust of the rooms. (See "Formaldehyde.") 

If formaldehyde is not available the next best process is that 
of washing all surfaces with a disinfecting solution (Solutions I, 
2, 6 or 7). Floors, particularly, should receive careful treatment 
and the solution should wet all the dirt in the cracks. The ceiling 
must be brushed with a damp cloth to remove infectious dust and 
cobwebs. The walls should be wiped carefully with a sponge or 
cloth squeezed out frequently from the disinfecting solution. 
When the walls are papered, it will be a case of injured paper or 
incomplete disinfection. With a cloth dampened in the disinfect- 
ing solution wipe the dust carefully from all surfaces that can 
harbor it. as furniture, moldings, doors, windows, etc. (See "Fur- 
niture.") 



SANITATION. 119 

Cotton and Linen Clothing. — The most trustworthy agency 
for the disinfection of clothing generally is moist heat — either 
steam or boiling. Steam disinfection wets the goods less than 
boiling, does not shrink woolens as much, and is less likely to 
change the colors of fabrics. This can be well done on a small 
scale in a common tin wash boiler by supporting a bottom of 
lath or a thin board above the water by two bricks, placing the 
infected articles in the chamber thus formed, covering them tightly 
and keeping the water boiling for an hour. Many kinds of cloth- 
ing that would be injured by boiling can be disinfected in this 
way without injury. After the steaming, the boiler should be 
carried immediately to the open air and the clothing thrown over 
a line. It will not usually be very wet, and will soon dry if 
spread out in the open air, while hot. If the clothing be put 
into the water and boiled thirty minutes its thorough disinfection 
is equally sure. 

When infected bed or body linen is removed, it may be 
treated differently according to circumstances. If stained, it 
should be soaked some hours in a disinfecting solution at a tem- 
perature not exceeding 120 degrees F. For this purpose Solu- 
tion 2, half strength, is especially appropriate, having the proper- 
ties of soap as well as of a disinfectant ; or Solution 1 mixed with 
an equal quantity of soap and water may be used. Subsequent 
boiling, as in ordinary laundry processes, will complete the disin- 
fection. Unstained clothing may be immersed in Solutions 1, 2, 
or 7, one-half strength, or in Solution 6, then treated as already 
advised ; or it may be boiled immediately. If Solution 6 is used, 
the clothing should be well rinsed before it is transferred to the 
wash boiler, to avoid corroding the latter. 

Clothing which has been wet is not readily penetrated by 
heat in steam disinfection. In transferring infected clothing from 
the sick-room, it should be wrapped in a sheet wet in a disinfecting 
solution, or simply in water if the disinfecting solution is not at 
hand. Infected clothing should never be sent to a public 
laundry. 

Woolen Clothing. — Disinfect with steam when available; 
when not, in solutions as under "Cotton and Linen Clothing/' or 
with large doses of formaldehyde. In a cask or box made air 
tight by pasting paper over it, calking, or some other device, 
clothing and other articles may be disinfected by pouring in 



120 SANITATION. 

with them upon a cloth to absorb it, formalin, or a mixture of 
one part formalin, one part wood alcohol, and two parts water, 
and leaving the box sealed up in a warm place for twelve hours. 

Bedding. — When steam disinfection is available, quilts, com- 
forters, blankets, pillows, etc., should be treated by it, and mat- 
tresses also if the apparatus is large enough. In the absence 
of a steam disinfector, even if the room is to be disinfected by 
formaldehyde, remove all bedding, excepting the mattresses, for 
steam disinfection in the wash boiler or in Solutions i, 2, 6 or 7. 
If these articles are left in the room their disinfection with formal- 
dehyde will be uncertain, so will the surfaces of furniture and 
floors covered by them. Disinfect pillows and feather beds with 
steam in the wash boiler, or with large doses of formaldehyde in 
small inclosures that are practically air tight, as the tight box 
or a small closet carefully calked. 

Mattresses. — Leave mattresses upon the bedstead wholly 
exposed to formaldehyde when the room is being disinfected. 
If the mattresses have been soiled by the penetration of dis- 
charges, as sometimes happens in typhoid fever, burn them. The 
only safe alternative is the injection of large quantities of formal- 
dehyde or formalin into their interiors while they are inclosed 
in a gas-tight covering. Mattresses of but little value should 
be burned. The contents of straw beds should be burned; the 
ticks may then be disinfected as for clothing. 

If the room is not to be disinfected with formaldehyde the 
surfaces of valuable mattresses should be washed with a sponge 
or cloth squeezed out of Solutions 1, 2 or 6. The removal of 
large pieces of bedding should be through a window into the 
open air instead of through other rooms. 

Furniture. — Simply leave all furniture in the room, with 
their parts well exposed to formaldehyde. If formaldehyde is not 
available, wash or wipe carefully every part of the surfaces with 
a soft sponge or cloth squeezed out of Solutions j, 2 or 6. Solu- 
tion 6 must not be used upon gilt or metallic articles. 

Upholstery, the unfinished backs of furniture, cracks and 
places where dust has lodged, must be washed with special care. 
After this treatment upholstered furniture should be carried out- 
doors and exposed to direct sunshine several days. Pictures 
covered with glass may be rubbed with a clamp cloth; those not 
thus covered should be wiped with a soft, dry cloth. The common 



SANITATION. 121 

practice of purchasing furniture, especially upholstered furniture, 
at second-hand stores cannot be too strongly condemned. Surely 
no prudent person who understands the nature of infection and 
contagion, or the methods of their dissemination, can consent to 
take such articles into his home, without any knowledge of the 
place from which they came, and assume that they are not reeking 
with scarlet fever, diphtheria or other germs. 

Rugs and Carpets. — Disinfect rugs with steam or formalde- 
hyde the same as "Bedding." Fur rugs must not be steamed. 
(See "Furs.") If, unfortunately, a carpet was left upon the 
floor of a sick-room, it should be removed before the room is dis- 
infected, and treated as follows : Disinfect with steam if the 
appliances are available, but if these are not obtainable, use formal- 
dehyde as for "Bedding." If neither steam nor formaldehyde 
can be used, spray or sprinkle the carpet on both sides until 
thoroughly wet with Solutions I, 6 or 7. The only other way 
is burning, and this is the best course for carpets and rugs of 
little value. 

Furs, Skins, Etc. — These can be efficiently disinfected only 
by formaldehyde as for "Bedding, " or by spraying or sprinkling 
very thoroughly with a disinfectant. Solution 6, or the tight 
box with formaldehyde, is best. 

Boots, Shoes and OtJier Leathern Articles. — Wash in Solu- 
tions 1, 2, 3, or 6, or expose to formaldehyde. 

Excreta. — In the sick-room the discharges from the boweis 
may be treated with any of the solutions herein given except Solu- 
tions 6 and 7. 

Disinfecting solutions should act three or four hours, at 
least. A still longer time is better. The quantity used of I, 
2, or 3 should be at least twice the volume of the discharge; if 
4 or 5 is used, the quantity should be much larger. The intimate 
mixture of the solution and the matter to be disinfected is impor- 
tant. A sure way to disinfect fresh excreta is to pour upon it 
in the vessel at least three or four times its volume of boiling 
water, then cover the vessel and let it stand until cool. 

Privy Vaults. — Disinfect with Solution 4 or 5, used in 
large quantity, sufficient to thoroughly saturate the contents ; 
after the vault is emptied pour in pailful after paiiful of the milk 
of lime until the ground beneath the privy is completely saturated 
with it. Cesspools should be disinfected in the same way. 



122 SANITATION. 

Water Closets. — If they have received infectious excreta, the 
howls of water closets should be scrubbed out with Solutions i, 
2, or 3. 

Sputa. — Fresh tuberculous sputum is hard to disinfect. It 
may be received on pieces of cloth or paper and burned. In spit- 
toons it may be disinfected with Solutions 2, 3, or 1. The effi- 
ciency of these solutions is increased by using them hot, and 
Solution 1 is made still more effective by adding to each gallon two 
ounces of hydrochloric acid, or twelve to fourteen ounces of 
common salt. These solutions should act twenty-four hours — 
necessitating several spittoons for the patient. 

Tuberculous sputum may also be disinfected by filling the 
spittoon with boiling water, covering it and letting it stand until 
cold. The cleansing of the spittoon will be facilitated by 
adding washing soda before the hot water is poured in. Other 
infectious sputa should be treated the same as tuberculous sputum. 

Corpses. — Wrap in a sheet wet in Solutions 6, 7, or 2, and 
bury as soon as possible. 

Mouth and T/iroat of the Atte?idant. — As a preventive, rinse 
them in a solution of five drops of formalin to one ounce of water. 

Clothing of Nurses and Physicians. — Steam is preferable, or 
the suit may be put into a tin wash boiler, or gas-tight box, and 
a rag, wet with two or three ounces of formalin, placed beside 
it, then the box closed tightly and left during the night. The 
clothing must not be worn again until thoroughly aired. 

HOW TO MAKE THE HOME HEALTHY. 

Make large provision for the free circulation of air and the 
admission of sunlight, insure good drainage, and see to it that 
there are no stagnant pools and sewage accumulations. Burn all 
combustible debris, clean out ditches and allow no vegetation to 
grow in them. Vaults and cesspools must be frequently emptied, 
and the contents removed far from buildings and covered with 
earth, and during the cleansing such places should be liberally 
treated with Solution 4 or 5, and with dry earth. As ordinarily 
arranged, the cesspool is an abomination that should not be tol- 
erated, for it places corruptible matter in the best condition for 
the long-continued generation of microbes, from which to infect 
the air and water of the neighborhood. Where sewer connections 
are impossible, let drainage from the kitchen sink be conducted to 



SANITATION. 123 

some distance from the house, through a movable pipe, and dis- 
charged upon the surface of ground exposed to the sun, and 
where no vegetation is allowed to grow ; move the pipe so that 
it shall discharge in a fresh place each week, and as the ground 
that has been soaked becomes partially dried treat it liberally 
with Solutions 3, 4, or 5. The disposition for any considerable 
time, of such matter, by seepage from underground pipes, is 
likely to prove a delusion and a snare. Do not attempt it. 

In cleaning buildings, secure if possible a free circulation 
of air under them ; especially see to it that there are no damp, 
moldv rooms ; bring- out and burn all decavine; rubbish found 
in attic or cellar, and with freshly slaked lime whitewash the cellar 
and attic walls. 

PATENT DISINFECTANTS. 

Many inventors have tried their hands at mixing disinfecting 
compounds, and to their nostrums have given fanciful names to 
catch the popular ear and secure their sale. It is doubtful if 
any of them possess any real advantages ; many of them are abso- 
lutely worthless. Because a substance emits a powerful odor is 
no proof that it is a disinfectant ; on the other hand, those com- 
pounds that have a pleasing smell seldom have any disinfecting 
properties, and, by creating a mistaken idea of security, may do 
more harm than good. To secure reliable results we must first 
know what we want to do, then how to do it ; and we can never 
be sure of accomplishing what we wish with patent compounds 
whose compositions are kept secret. 



MATERIA MEDICA. 

By Louis C. Duncan, M.D. 

INTRODUCTION. 

Materia medica is the science of the materials used in treating 
the sick. It includes not only drugs, but also foods, air, water, 
electricity, and serums, besides agents not describable in a brief 
chapter. With the exception of water, only those remedies known 
as drugs will be considered here. They are vegetable, mineral and 
animal in origin, and are prepared in the forms of pills, tablets, 
solutions, tinctures, extracts, etc. 

A solution is either a solid or gas transformed to the liquid 
state through the agency of a liquid which is called the solvent. 
When the solvent will dissolve no more of a substance, the solution 
is called a saturated solution of that substance. 

A mixture is a fluid containing some drug not dissolved, but 
held suspended in it. 

An emulsion is a milk-like mixture, usually prepared by 
mixing an oil and an alkaline or mucilaginous fluid. 

A decoction is a solution made by boiling. 

An infusion is a solution made by steeping in water. 

An extract is prepared by evaporation of the juice of a plant 
almost to dryness. 

A tincture is prepared by dissolving an extract in alcohol. 
An extract is stronger than a tincture. 

A trochee or lozenge is a button-shaped mass of drug, in- 
tended to be dissolved in the mouth. 

A tablet is like a trochee, but smaller, and is to be swallowed. 

Tablets are generally to be preferred to the hard-coated pills, 
since they dissolve more readily in the stomach, but, on the other 
hand, they lose strength more rapidly with age. 

"It may be startling to the uninitiated, but it is nevertheless 
true, that from among the fiercest poisons come some of the most 
valuable medicines. A knife of very keen edge, when used with 
a light and dexterous hand, will make a cleaner and better wound 

125 



126 MATERIA MEDIC A. 

than the blunter instrument which has to be pressed heavily on 
the part ; and so a remedy of greatest power, when skillfully 
timed and apportioned to the varying progress of the case, is often 
safer and more valuable, under urgent and dangerous circum- 
stances, than the "simples" of the timid practitioner. A few small 
doses of the one may turn the current of disease, and save a 
precious life, where the large and sustained doses of the other 
would prove unavailing. Prussic acid, aconite, strychnia, arsenic, 
opium and belladonna are at once intense poisons and admirable 
medicines in the hands of the skillful," but, it can hardly be neces- 
sary to add, as domestic remedies they have little place. They 
are mentioned here, not to encourage their use in home treat- 
ment, but to inform the layman as to some of the weapons em- 
ployed by masters in the healing art, and, that, apprised of their 
true character and the effects they may be expected to produce, 
he may more fully realize the importance of using them exactly 

as prescribed. 

GENERAL TONICS. 

A Tonic is a remedy that increases the strength, and gives 
vigor of action to the system. 

Cod Liver Oil. — Cod liver oil is one of the best tonics to 
restore and build up the system in all wasting diseases. Not 
only is it indicated in consumption, but in a large number of other 
diseases, such as marasmus of infants, rickets, nervous exhaustion, 
chronic bronchitis, scrofula, rheumatoid arthritis, and anemia. 
It is best given pure, and, owing to its nauseous taste, should be 
given in a single, large dose once a day. Many cannot take it 
pure, and for such an emulsion must be made. One of the most 
palatable is an egg emulsion put up by Parke, Davis & Co. Not 
many can digest more than three teaspoonfuls of the pure oil per 
day. It should be taken for weeks at a time. 

Iron. — While iron is a general tonic, its special action is upon 
the blood. It increases the number of red blood corpuscles, as 
well as the amount of hemaglobin. It is indicated in all affec- 
tions that weaken the blood; as anemia, chlorosis, leucemia, 
tuberculosis, diabetes, rheumatoid arthritis, cancer, and Bright's 
disease, also in neuralgia and erysipelas. 

The old preparation, tincture of chloride of iron, still holds its 
place as one of the best. It should be given in doses of five 
to fifteen drops, well diluted, and kept from the teeth as much as 



MA TERIA MEDIC A . 127 

possible. There are modern preparations which are more palat- 
able. "Pepto-mangan" is as good as any of them. They all have 
a constipating effect, and for that reason should not be given long 
without interruption. They are best taken after meals. Taken in 
large doses iron is likely to disorder the stomach. 

Arsenic. — Arsenic, in small doses, strengthens the action of 
the stomach and is a general tonic. It also has a special effect 
upon the skin, and is said to clear the complexion. It improves 
the breathing or "wind.'' When too long continued it irritates 
the stomach and produces a puffiness under the eyes which is a 
danger signal. Arsenic is useful in all debilitating diseases. It 
will give good results in the beginning of tuberculosis, anemia, 
malaria, diabetes, nervous exhaustion, chlorosis and other diseases 
of the same weakening nature. It is also useful in all chronic 
skin diseases. It is the principal ingredient of the various "cancer 
pastes" of the quack cancer doctors, and enters also into a compo- 
sition used very generally by dentists to destroy the nerves of 
teeth. 

Fowler's solution of arsenic is the safest as well as the most 
convenient form. The dose should begin at five drops once in 
six hours, and gradually increase to twenty or thirty. The eyelids 
must be very closely watched, and if they begin to puff, the arsenic 
must be stopped for a while. 

Quinine. — In small doses, quinine is a very valuable general 
tonic. For this purpose from six to ten grains per day should 
be given. The compound tincture of cinchona may be used in- 
stead, in doses of from one to four drams, three times a day. The 
taste may be disguised by taking it in quinimal, or verba santa 
syrup, or it may be taken in lozenges or in capsules. 

Bitters. — Of the various bitter tonics used to stimulate the 
stomach, promote the appetite and better the general health, the 
chief ones are columbo, dogwood, quassia and gentian. The 
dose of each is from one-half to two drams. Nux vomica tincture, 
in five drop doses, and strychnia, one-sixtieth of a grain, may be 
included in this list. Iron, quinine and strychnia are now com- 
bined in an elixir which is regarded as quite generally useful. 
Let it be remembered, however, that loss of appetite and nausea 
are often nature's agents for calling a halt that the stomach, liver 
and other over-worked organs may have needed rest, and that 
at such times far more harm than good may result by overcoming 
these protests by bitters, or tonics of any kind. 



128 MA TERIA MEDIC A . 

Mercury, in small doses, is said to be a tonic. For this pur- 
pose, calomel, in one-fourth grain doses, three times a day, is the 
safest form. 

Phosphorus and the hypophosphites are useful in all cases of 
nervous exhaustion. The dose of phosphorus is one-hundredth 
of a grain in a pill ; but of the syrup of hypophosphite from one 
dram to one ounce may be taken. 

HEART STIMULANTS. 

Strychnia. — Strychnia sulphate is a white crystalline powder 
having an intensely bitter taste. The dose is from one-sixtieth 
to one-thirtieth of a grain. Strychnia stimulates both the heart 
and lungs, raises the body temperature, increases the muscular 
powers and renders the special senses more acute. Strychnia is 
useful in cases of paralysis, constipation, chronic bronchitis, be- 
ginning consumption, anemia, etc. It is an active poison, and an 
antidote to poisoning by chloral or chloroform. 

Nitro Glycerin is a colorless, oily liquid, soluble m alcohol or 
ether. It explodes if heated in a closed vessel, or subjected to 
percussion. It is also known as glonoin and trinitrin. Its action 
on different persons differs so widely, it is difficult to say what the 
dose is. It varies from one to fifty drops of a one per cent solu- 
tion. It causes the heart to beat both more rapidly and more 
forcibly, and, at the same time, lessens arterial tension, thus lessen- 
ing the work of the heart. It is a remedy which can be used 
safely only by a physician. 

Digitalis. — The tincture of digitalis is prepared from the leaves 
of the wild fox-glove. It causes the heart to beat more slowly and 
more forcibly, but also narrows the caliber of the arteries, thus 
giving it more work to perform. The dose is from one to ten 
drops. Patients who have been taking digitalis should not rise 
from the recumbent posture suddenly. It is one of the best 
diuretics known. Its principal use is in diseases of the heart, for 
which it is used extensively. It must be remembered that it is a 
dangerous poison, and be employed very cautiously. 

Caffeine. — The citrate of caffeine is a white crystalline powder 
obtained from the ordinary coffee berry. The usual dose is five 
grains. Its most important action is to stimulate the heart and 
circulation. Its action on the heart resembles that of digitalis, 
causing the heart to beat more slowly and forcibly. At first it 



MATERIA MEDIC A. 129 

produces a drowsy feeling, and later stimulates the brain. It is 
an effective remedy for that particular form of headache which is 
associated with disturbance of the stomach and known as nervous 
or sick-headache. It is also useful in dropsy. 

Alcoholics. — While alcohol in quantity is a narcotic, in small 
doses (and it is never given medicinally except in small doses), 
it is a stimulant. It increases the action of the heart and the cir- 
culation, causes a slight rise in temperature, produces a feeling of 
exhilaration, and aids digestion. An overdose produces almost 
the exact opposite of these conditions, and the evil effects of 
prolonged indulgence, in quantities above the medicinal dose, are 
well known. The dose may be placed at from one to two ounces 
of whisky or brandy, which contains nearly fifty per cent of pure 
alcohol. Of the wines and lighter preparations more may be 
taken. 

Alcoholics are useful, in fact almost indispensable, in many 
conditions, such as the very low stages of any disease, con- 
valescence, prolonged wasting diseases, severe hemorrhage or in- 
jury, the bite of a poisonous serpent, and poisoning by agents 
which depress the heart. Alcohol is also an antiseptic, useful ex- 
ternally in washes and liniments. 

ALCOHOLIC STRENGTH OF LIQUORS. 

Alcohol 50 to 99$ 

Rectified Spirit 85^ 

Proof Spirit 50$ 

Whisky 44 to 50$ 

Brandy 39 to 47$ 

Rum and Gin 42^ 

Port Wine 30 to 40$ 

Sherry Wine 25 to 30^ 

Light red wines — Claret, Red Rhine, Concord, etc. . . 5 to 7$ 

Dry acid Wines — Rhine, Moselle, Ohio, etc 5 to 7$ 

Sparkling wines — Champagne, Hock, Catawba, etc.... 8 to 12$ ■ 

Sweet wines — Burgundy, Tokay, Madeira, Angelica ... 6 to 7^ 

Beer, Ale and Porter 2 to Gfc 

Koumis 1 to 3 per cent. 

ANTIPYRETICS. 

Antipyretics are remedies which reduce the temperature of 
the bod}-; in other words, lessen fever. As a rule, they have no 
effect on a normal temperature. Some act by abstracting the 
9 



180 MATERIA MEDIC A. 

heat irom the body; others by lessening the production of heat by 
slowing- the heart and diminishing the processes of the body ; and 
others by removing the elements which produce the excessive 
heat, as quinine given in malarial fever. Those of the last class 
are usually the best, but the others are sometimes necessary. 

Water. — Water is one of the safest and best of antipyretics. 
For reducing fever it may be used as a bath, or for sponging the 
body. As a rule it may be drunk freely. The bath may either 
be cold (40 to 60 degrees F.), temperate (60 to 85 degrees F.), or 
tepid (85 to 95 degrees F.). When a physician is not at hand the 
tepid or temperate bath is safest. If the patient cannot be placed 
in a tub, the wet pack may be used. A linen sheet is wrung from 
cold water, the patient placed in the middle of it, and both sides 
folded over him, and he is then covered with blankets. The 
length of time that he should remain in the pack is from fifteen 
minutes to one hour, and when removed, he must be well rubbed 
with dry towels. If there is objection to the pack, sponging may 
be substituted. The face and neck are first sponged, then the 
arms, and so on until the whole body has been treated. Though 
not as efficient as the tub bath or pack, sponging also makes the 
patient feel more comfortable and cool, and reduces the tem- 
perature quite appreciably, and by many physicians is preferred 
to either of the other methods, as being more convenient, shocking 
the patient less, and involving less risk, and by repetition giving 
quite as good results (through opening the pores of the skin and by 
the cold produced by evaporation). It is a rule, followed by many, 
in continued fevers to give the bath or spongings whenever the 
temperature goes above 103 degrees, and as often as may be 
necessary to keep it below that point. There is no doubt that such 
measures are more certain and safe than all the fever drops, 
antipynms and antifebrins that have ever been devised. The old 
notion that fever patients should not be allowed to drink cold 
water freely has given way to more humane and sensible ideas. 

Quinine. — Omnia bisulphate is, after water, the most success- 
ful antipyretic. Though it has the most marked effect in the 
fevers called malarial, it is useful in nearly all fevers. It acts as an 
antiseptic in the fluids of the body, and has a specially fatal effect 
upon the germ of malarial fever, and for this fever is an absolute 
cure. That there are rare exceptions does not disprove the rule. 
For this, as well as for other fevers, large doses are required. 



MATERIA MEDIC A. 131 

Thirty grains a clay usually suffice for an adult, but in cases of 
pernicious malaria, and the so-called congestive chill, larger doses 
may be given up to sixty grains in twenty-four hours. It should 
be divided into six equal parts and one taken every four hours. 
The deafness that sometimes follows heroic doses is seldom per- 
manent. 

Quinine is also destructive of other disease germs. In blood 
poisoning, erysipelas and childbed fever quinine is extremely use- 
ful. It has an important place in the treatment of cerebro- 
spinal meningitis, measles, scarlet fever and pneumonia. A large 
dose at the beginning will often "break up" a cold, or even a case 
of pneumonia or pleurisy. In typhoid and typhus it has little 
effect. 

Quinine should be given in the natural state or in capsules 
when possible. If the taste is to be disguised, it may be given in 
some of the preparations now in vogue ; such as verba santa, 
yerbazine. quinimel, etc., or the chocolate lozenges may be given. 
The hard coated pills and tablets cannot be recommended. Qui- 
nine bisulphate does not differ materially from the sulphate com- 
monly used. 

Ant i pyrin, Phenacetin and Acetanilide. — These three modern 
drugs are much alike in their derivation, properties and effects. 
The}" are white powders, and are made from coal tar. The dose 
oi each is from three to ten grains. Antipyrin is the most efficient 
as an antipyretic. By a full dose the temperature in fever may be 
reduced one or two degrees, or even to sub-normal, the decline 
beginning in ten to fifteen minutes, and lasting from two to ten 
hours. Besides reducing fever, they have a quieting effect upon 
the nervous system, and lessen pain in any part' of the body, but 
care must be exercised in their use because of their depressing in- 
fluence upon the heart. Phenacetin is the safest of the group, 
and antipyrin stands next. The preparation in tablet form known 
as acetanilide compound is generally useful in slight fevers, neural- 
gia, headache, rheumatism, etc., and is comparatively safe, for the 
acetanilide is here combined with caffeine, which, being a heart 
stimulant, counteracts its possible depressing effects. One tablet 
contains three grains and is a dose. Antipyrin is the best known 
drug for the reduction of fever, but, unfortunately, it has no effect 
on the cause of the fever; therein lies its inferiority to quinine. 
Acetanilide is sometimes called antifebrin. Antipyrin with salicy- 



13 k ^ MATERIA MEDIC A. 

late of soda is effective in relieving rheumatic pains. Most head- 
ache tablets contain one of these drugs. 

Aconite. — The tincture of aconite is prepared from the root 
of aconitum napellus or monkshood. The dose is from one-half 
to five drops. Although it has other powerful effects, its prin- 
cipal use is as a heat reducer. It is much employed by homeop- 
athic practitioners (although its action is in direct opposition to 
their great principle of "similia, etc."), because a very small quan- 
tity will produce a very marked effect. It slows both the heart 
and the respiration, reduces arterial tension, lowers the tem- 
perature, induces muscular weakness and lessens the nervous 
sensibilities, i 

In large doses, or rather, in what of other drugs might be 
called a small dose, it is an active poison and for this reason is a 
drug not suitable to be used as a home remedy. It is useful in 
slight fevers, bronchitis, pneumonia, pleuritis, scarletina, erysipe- 
las, acute rheumatism and neuralgia. It should not be given in 
continued fevers, as typhoid, and is of no real advantage in 
malarial fevers. It should never be given to a very weak patient. 

ANTISEPTICS. 

Antiseptics may be defined as agents which arrest the action 
of germs. They are useful in many internal diseases resulting 
from germ action, as stomach disturbances, diarrhea, dysentery, 
and typhoid. Many of the modern antiseptics are derived from 
coal tar by distillation. 

Carbolic Acid is a coal tar product, and one of the most pow- 
erful antiseptics. It occurs in white crystals, but that sold in the 
drug stores is a watery solution which, if nearly pure, crystallizes 
again in moderate cold. The dose is from one-fourth to one 
grain, or from one-half to two drops, well diluted. It is useful 
in vomiting, fermentation in the stomach or intestines, cholera 
infantum and cholera morbus. For internal use, creosote and 
gnaiacol are preferable. Weak solutions of carbolic acid are 
much used as external antiseptics. 

Creosote resembles carbolic acid, but is derived from wood 
tar. The best creosote is made from beech wood. It may be 
used in place of carbolic acid in the diseases mentioned. The 
dose is from two to five drops. 

Guaiacol is similar to creosote, and the same dose may be 



MATERIA MEDIC A. 133 

given, and either may be given in cod liver oil, brandy or whisky. 
Both have a peculiarly destructive action on the germs of tuber- 
culosis and for that reason are much given in cases of consumption, 
and with good results. 

Salicylic A cid occurs in small white crystals. The dose is 
from ten grains to one dram. Large doses disturb the stomach. 
Salicylic acid arrests fermentation, lowers the body temperature, 
and is useful in diarrhea and typhoid. Its special use is in acute 
articular rheumatism, commonly known as inflammatory rheuma- 
tism. Powdered salicylic acid makes an excellent dusting powder 
for ulcers, eczemas, etc. 

Salicylate of Sodium is much like salicylic acid but is even 
more effective. For acute rheumatism it comes very near to 
being a certain cure. It is also useful in chronic rheumatism, 
muscular rheumatism, neuralgia, lumbago and gout. In all these 
affections it may be given conjointly with antipyrin. The dose is 
from ten to thirty grains. 

Salol. — Salol is made by combining sixty parts of salicylic acid 
with forty parts of carbolic acid, and is, perhaps, the best anti- 
septic for internal use. It is a white powder, tasteless and in- 
soluble in water. The dose is from five to thirty grains. When 
large doses are given continuously there is danger of carbolic 
acid poisoning. It is useful in all fermentations in the stomach 
and intestines, in all suppurative processes, in acute tonsilitis, 
rheumatism, neuralgia, la grippe, and typhoid. It is one of the 
best agents known for rendering the urine antiseptic in diseases 
of the bladder, prostate and urethra. 

Boric Acid, or boracic acid, as it is sometimes called, is a 
mild antiseptic. Its principal use is external, for mild eye washes, 
and as a dusting powder. A four per cent solution, which is a 
saturated solution of this acid if the water is cold, is an excellent 
mild antiseptic wash for general use. Powdered boric acid may be 
used on all kinds of ulcers, burns, scalds, and external wounds. 

Borax, or the borate of sodium, has much the same properties 
as boric acid. 

Bismuth Subnitrate is a grayish white powder of mild anti- 
septic power. It may be given with much benefit in simple in- 
flammations of any part of the gastro-intestinal tract ; it gives relief 
in each, whether it be the stomach, small intestines or colon. It 
has usually been given in too small doses. To obtain the desired 



134 MATERIA MEDIC A. 

result, from one-half to one dram should be given every three or 
four hours. As bismuth is not a poison, very large doses may be 
given. It is also useful externally in cases of sore mouth, ulcers, 
burns, etc. 

The list of diseases benefited by bismuth is a long one, in- 
cluding acute indigestion, inflammation of the stomach, ulcer and 
cancer of the stomach, summer diarrhea and cholera infantum, 
vomiting, diarrhea of typhoid, chronic diarrhea, diarrhea of con- 
sumption, and some cases of stomach neuralgia. It is best given 
in milk, and on an empty stomach. It colors the stools dark, and 
sometimes produces constipation. Bismuth subgallate, or der- 
rnatol, has much the same action, and is, perhaps, superior for 
external use. 

Menthol occurs as colorless crystals derived from the oil of 
peppermint. It is frequently put up in the form of a cone, stick or 
pencil for external use. It is also used in washes, sprays and 
gargles, and seems especially beneficial in the affections of the 
throat. It is useful in neuralgia of the face, certain headaches 
and toothache. In cases of neuralgia the solid stick is rubbed 
over the surface until the skin reddens. 

Hydrogen Peroxide is a clear fluid, and an excellent external 
antiseptic and deodorant. Its especial use is in suppurating 
cavities, or on surfaces, which it cleans more effectively than any 
other agent. It seems to have an affinity for pus, and, when 
they come in contact, unites with it to form a sort of foam which 
is easily washed away. It ma> be diluted or used full strength. 
It should be kept in an amber bottle in a dark place, and well 
corked, as it loses strength on exposure. 

Bichloride of Mercury. — This is the most powerful of all anti- 
septics. It should never be taken internally, except on prescrip- 
tion by a physician. For external antiseptic purposes, solutions 
are made varying in strength from one to fifteen grains to the pint 
of water. For application to the body a stronger than a two grain 
solution should not be used. For general disinfecting purposes, 
destroying vermin on beds, etc., a fifteen grain solution may be 
used. It should always be borne in mind that the bichloride is a 
deadly poison. 

Chlorinated Lime is a grayish white substance, occifrring in 
powder or lumps. It is useful for disinfecting excreta, vaults, 
etc., for which it is vastly superior to the quick lime often used. 



.1 1 A TERIA MEDIC A . 1 35 

Charcoal. — Ordinary charcoal is a useful antiseptic and de- 
odorant. It acts by absorbing poisonous substances. When 
used in filters it must be renewed occasionally. Powdered char- 
coal may be given internally in doses up to a dram. 

Permanganate of Potash occurs in deep purple crystals. Its 
solution may range in color from a light rose to a deep purple, de- 
pending on the strength. One to two grains may be given in- 
ternally. It may be administered whenever an internal anti- 
septic is needed, but its principal use is in solutions for washing 
out cavities, cleansing foul ulcers, etc. It has recently been learned 
that the permanganate of potash is an antidote for morphine poi- 
soning; a grain of the potash neutralizing a grain of the morphine. 
When injected into the part bitten by a poisonous serpent the 
action of the poison is arrested. 

Iodoform is a yellow powder having a very pronounced and 
disagreeable odor. It has long been the favorite powder for 
dusting burns, abrasions, closed wounds, etc., but it is giving way 
to other preparations more efficient and elegant. For this pur- 
pose boric acid, bismuth, quinine, acetanilide, salicylic acid, soda, 
or one of several other powders may usually be substituted. 

Tincture of Iodine. — The tincture of iodine is a brown-colored 
liquid, having a more important place in the list of home remedies 
than in the practice of the physician. It stains the skin a dull 
yellow and acts as an irritant. Painted over swollen glands and 
local inflammations, before the formation of pus, it will sometimes 
prevent that condition. It also hastens the absorption of fluids, 
and for this reason is painted on the chest in cases of pleurisy with 
effusion, and on inflamed joints containing fluid. It is also in- 
jected into goiter, enlarged tonsils, and glandular growths about 
the neck. 

Ichthyol is another of the new remedies, derived from coal tar. 
It is a dark, semifluid substance having the odor of bitumen. It 
may be used in most cases where iodine has heretofore been used, 
and is decidedly superior to that drug. It dissolves in water, 
ether or alcohol, and mixes readily with vaseline, lard and oils to 
make ointments. For reducing the inflammation and relieving 
the pain of sties, boils, felons, carbuncles, and similar affections, 
it has no equal. For this purpose it should be dissolved in three 
times its bulk of alcohol and ether, and this preparation painted on 
the inflamed part every hour, or as often as may be necessary 
to relieve pain. 



136 MATERIA MEDIC A. 

Zinc Sulphate is a white crystalline substance, used in solution 
and mostly externally. Solutions varying from one to six grains 
to the ounce are used. Given internally, in doses of from one-half 
to one dram, it is an active emetic. 

EMETICS. 

Emetics are medicines which cause vomiting. The prompt 
use of an emetic is often necessary to free the stomach of poison, or 
other objectionable materials, and sometimes greatly relieves 
headache, hysteria, convulsions in children, and other troubles, 
when the cause is a disordered stomach. They may also be valu- 
able agents in the removal of obstructions from the throat or wind- 
pipe. 

Warm Water, when taken in large quantities, is usually an 
efficient emetic, especially if vomiting has already begun ; and 
copious draughts of it materially aid the action of other emetics. 

Mustard is a safe emetic, and one which is at hand in almost 
every home. Besides being an emetic it is also a stimulant. One 
or two teaspoonfuls of powdered mustard, stirred into a cup of 
warm water and taken warm, is usually sufficient. 

Alum. — Powdered alum is another common drug which may 
be used as an emetic. It is slow but safe and reliable. Vomiting 
does not occur for a half-hour after it has been taken. It is 
especially recommended for croup and diphtheria, as an. aid in the 
removal of the false membrane, and to prevent the formation of a 
second one. The close is a teaspoonful. It may be taken in 
syrup, and should be repeated every forty minutes until there is 
free vomiting. 

Squill or Scilla. — The compound syrup of squill, or "hive 
syrup/' is another active emetic, but its action is partly due to the 
tartar emetic which it contains. The dose is from five drops to a 
teaspoonful. It is not as safe as some other emetics. 

Ipecac is an efficient and safe emetic for all ordinary purposes. 
The time required for its action is from twenty to thirty minutes. 
It produces no depression or bad after effects, and, in weak con- 
ditions, is safer than the mineral emetics. The dose is from five to 
sixty grains of the powdered root. 

Sulphate of Copper, or blue vitriol, is a prompt emetic, acting 
in a few minutes. It is useful in many cases of poisoning, es- 
pecially in phosphoric poisoning. From five to ten grains may 
be given, dissolved in a few ounces of water. 



MATERIA MEDIC A. 137 

Sulphate of Zinc, or white vitriol, is also an emetic, similar in 
its action to the sulphate of copper, but is said to be less irritating 
to the stomach, and not as powerful. A half-teaspoonful of the 
sulphate should be given, dissolved in water. The action of this, 
as of most emetics, is aided by drinking freely of lukewarm 
water. 

Tartar Emetic is a tartrate of antimony and potassium. It is 
a powerful emetic, but depressing, and its use as a home remedy 
is attended with danger. A good way to give it is to dissolve five 
grains in a half-teacup of water, and give a tablespoonful of the 
solution every fifteen minutes until vomiting is produced. 

Apomorphine is one of the quickest and most effect- 
ive of all the emetics. Usually not more than ten minutes elapse 
after taking until vomiting begins. The dose, when taken into 
the stomach, is one-eighth of a grain. It is most commonly given 
by means of the hypodermic syringe, the dose then required being 
one-sixteenth of a grain. It produces free and easy vomiting with 

but little nausea. 

DIURETICS. 

Diuretics are remedies which increase the flow of urine, either 
by stimulating the kidneys, or otherwise. The principal diuretics 
in use are water, sweet spirits of niter, digitalis, the acetate and 
the citrate of potash, oil of turpentine, copaiba, cubebs, buchu and 
squills. 

Water. — Water is, perhaps, the safest and best of all the 
diuretics for general use. To act as a diuretic it must be drunk 
in quite large quantities. It works in a purely mechanical way, 
washing out and cleansing the kidneys. There are cases, how- 
ever, where instead of relieving it adds to the difficulty. Milk, too, 
is diuretic in its action and at times is preferable to water, not 
onh acting on the kidneys but also nourishing the patient. 

Sweet Spirits of Niter ; or the nitrous spirits of ether, is a well 
known home remedy, but none the less effective on that account. 
It is a clear, sweet liquid, pleasant to take, and usually productive 
of the desired effect. The dose is from a half-dram to a half-ounce. 
It should not be kept long, as it rapidly deteriorates. 

Digitalis has been described under the head of "Heart Stimu- 
lants." It is especially useful in dropsies, but must be used with 
great care. 

Potash Salts. — The acetate, citrate and bitartrate of potash 



138 MATERIA MEDIC A. 

are all excellent diuretics. From five to twenty grains may be 
given, well diluted, three times a day. Large doses often disturb 
the stomach. They are useful for keeping the urine alkaline, and 
in many cases of Bright's disease, and in valvular disease of the 
heart. 

Oil of Turpentine is a popular household remedy, and justly 
so. The dose should not be over thirty drops. Taken internally, 
in proper dose, it acts as a diuretic, but in large doses it produces 
scanty, bloody urine, with a frequent desire to urinate, pain and 
straining. In medicinal doses, it also stimulates the heart and 
circulation, and acts as an antiseptic in the stomach and intestines. 
It dries up discharges from the lungs, and from the bladder and 
urethra also. Y\ nen applied externally over the kidneys, it has a 
slight diuretic effect, and often will relieve pain in the kidneys. 
It is a good counter irritant, and enters into the composition of 
many liniments. The steam from heated turpentine and water 
may be used in cases of croup, etc. 

Balsam of Copaiba is a diuretic, principally used for its heal- 
ing effect upon inflamed mucous membranes of the urethra and 
bladder. The close is from ten drops to a teaspoonful, but large 
doses may produce indigestion. It is nauseous and very difficult 
to take. It has been much used in venereal diseases. 

Bitchu and Cubed s are two vegetable preparations much used 
in patent nostrums. Neither is of much value. Cubebs have 
the same uses as copaiba but are not as effective. 

Squills is one of the old time remedies, now becoming obso- 
lete. The dose is from one-half to one dram. It is used as an 
expectorant in many cough mixtures, and as a diuretic. It is irri- 
tant to the stomach, and when an overdose is given produces 
vomiting. It should never be given when there is any disturbance 
of the stomach, nor to young babies in any case. It is effective 
as a diuretic, but an overdose produces inflammation, straining 
and bloody urine or suppression of the urine. 

CATHARTICS. 

Cathartics are medicines that promote intestinal discharges, 
and thus cleanse the stomach and bowels. They may be divided 
into several classes on the basis of their efficiency and rapidity of 
action: Thus we have laxatives or aperients, purgatives and 
cholagogues. 






MATERIA MEDIC A. 139 

Laxatives or Aperients are those remedies which excite only 
slight peristalsis, cause no irritation or pain, and produce softened 
stools in ten to twelve hours. 



Sulphur dose, one to three drams. 

Ox gall dose, two to four grains. 

Cascara, fluid extract dose, fifteen to forty drops. 



Purge comes from two Latin words meaning to make pure, 
and purgatives are medicines having the power to cleanse the 
bowels. They are more severe and thorough than laxatives, and 
are of three principal classes : Simple, saline and drastic. 

The Simple Purgatives increase peristaltic action, and stimu- 
late the secretions of the intestinal glands, cause more copious 
discharges than the laxatives, and some irritation and griping. 
They operate in eight to ten hours, and produce one or more 
watery stools. The following are of this class : 

Castor oil dose, one to eight drams. 

Senna, fluid extract dose, one-half ounce. 

Rhubarb . . . . dose, one-half to two drams. 

Aloes dose, one to five grains. 

Castor Oil is a very reliable laxative, causes little irritation, 
pain or straining, and produces copious stools. It is an especially 
valuable laxative for children and pregnant women. In chil- 
dren's diarrhea caused by undigested food or irritating secretions, 
there is no better remedy. It has very little effect upon the liver. 
It may be easily taken in a half-cup of hot coffee or hot milk, and 
its offensive taste may be disguised by a few drops of wintergreen 
oil. 

Saline Purgatives are such salts as have the power to in- 
crease peristalsis, and to cause large secretions of fluid from the 
mucous membrane of the bowels, thus causing free watery stools 
in from six to eight hours. They include such medicines as 

Magnesia suiph. , or Epsom salts. . dose, one to eight drams. 

Magnesium citrate dose, one to four drams. 

Rochelle salts dose, one to eight drams. 

Seidlitz powders. 

The Drastic Purgatives are medicines which act still more 
intensely than the salines. They operate powerfully and quickly, 



340 MATERIA MEDIC A. 

producing violent peristalsis, griping and straining, and copious 
watery stools, in from two to six hours. In large doses they are 
dangerous, causing inflammation and symptoms of irritant poi- 
soning. The following are of this class : 

Jalap, comp. powder dose, ten to sixty grains. 

Scarnmony, comp. powder dose, five to ten grains. 

Coiocynth, comp. powder dose, five to ten grains. 

Compound cathartic pills dose, one to three. 

CJwlagogucs are medicines which are supposed to act upon 
the liver and cause flow of bile into the intestines. In about eight 
hours they produce free purging of watery stools of greenish color. 
The leading cholagogues are : 

Calomel dose, one-tenth to ten grains. 

Podophyllum resin dose, one-fourth to one grain. 

Aloes dose, one to five grains. 

Mercurial Purgatives increase glandular action, and empty 
the ducts of the liver. Their action is slow, producing several 
stools in from ten to twenty hours. In large doses they produce 
griping. 

Calomel dose, one-tenth to ten grains. 

Blue Mass dose, five to fifteen grains. 

Hydragogues are medicines supposed to be able to expel 
serum that has been effused into any part of the body. The 
cathartics of this class produce violent purging with watery stools. 

Gamboge not prescribed alone. 

Elaterium dose, one-sixteenth to one-fourth grain. 

Croton oil dose, one to two drops. 

In large doses these are dangerous. The salines are also 
hydragogue cathartics. 

WHAT CATHARTICS TO TAKE AND HOW TO TAKE THEM. 

Small doses of calomel, as one-tenth of a grain repeated every 
thirty to sixty minutes until a grain or more has been taken, give 
better results than large doses at longer intervals. In case 
thorough action is not obtained, follow in eight or ten hours with 
castor oil, or one of the salines. 

The best and safest cathartics, as general domestic remedies, 



MATERIA MEDIC A. 141 

are castor oil, magnesia sulphate, Rochelle salts, calomel and 
podophyllum. For chronic constipation cascara is a good remedy. 
It may be combined with aloes, strychnia and nux vomica, for, 
although the last two drugs are not cathartics, they stimulate 
peristalsis of the bowels and thus counteract constipation. It 
must be remembered that the last two are poisons, and are to be 
used only in very small quantities. (See "Poisons"). 

The too common habit of taking cathartics immediately upon 
the appearance of each and every disorder is most pernicious. 
These medicines are excellent in their places, but in cases of 
indigestion and constipation resort to drugs should be made only 
when a thorough trial of laxative diet, regular habits, pure air, both 
day and night, and outdoor exercise, have failed to overcome the 
disorder. A rectal injection also sometimes brings great relief in 
these cases, and must be counted among the valuable remedies, 
but, like drugs, it must be employed only when actually needed, 
for not only are too frequent injections likely to create a condition 
which makes their continuance more and more necessary, but they 
sometimes do great and irreparable injury by causing permanent 
dilatation of the rectum and its sphincters. 

HYPNOTICS. 

Hypnotics are remedies that produce or tend to produce sleep. 
The leading hypnotics are chloral hydrate, sulphonal and trional. 

Chloral Hydrate is a white crystalline substance, having a 
pungent odor and a burning, bitter taste. It is soluble in water, 
and is a useful remedy in tetanus and other nervous disturbances, 
delirium tremens, chorea, hysteria, strychnia poisoning, con- 
vulsions, etc. It does not cause headache or nausea, and does not 
constipate, as opium does. Combined with an equal part of bromide 
of potassium, it is excellent to quiet the nerves. The dose is 
from five to sixty grains. An overdose is dangerous. 

Sulphonal and Trional are coal tar preparations and occur in 
white tasteless crystals, soluble in hot liquids. They are better 
than chloral to relieve sleeplessness, and are also safer. There 
is a difference of opinion as to which is the better remedy, but 
trional seems to have the preference. Both are safe and reliable, 
and do not leave the after effects of opiates. The dose is from ten 
to twenty grains. Ten grains may be taken on retiring and not 
repeated. If that amount is not effectual, a larger dose should be 



142 MA TERIA MEDIC A . 

tried the next evening. They are patented preparations and are 
sold at exorbitant prices. 

ANTHELMINTICS. 

Anthelmintics are drugs which cause the expulsion of worms. 

Santonin is a colorless, crystalline substance having a bitter 
taste. It is very conveniently put up with calomel in a chocolate 
coated trochee. Of those containing one-half grain, from one to 
three are sufficient for a child. Santonin is especially effective 
against the round worm — ascarides lumbricoides. 

Male Fern. — The oil of male fern is an almost certain agent, 
if properly taken, for the expulsion of the tape worm. The dose 
is from one-half to two drams. This should be given in divided 
doses, preceded by a fluid diet and followed by an active purge. 

Pomegranate. — A decoction of the bark of the fresh root of 
the pomegranate is an effective tape worm remedy. A decoction 
prepared by boiling two ounces of the bark in a quart of water 
down to a pint is the average quantity required. This may be 
given in two ounce doses every hour until all is taken. 

Pumpkin Seed is one of the best remedies for tape worm. 
Two ounces of the fresh seed are pounded in a mortar with a half 
pint of water until the husks are loosened, and an emulsion made. 
The husks are strained out and the emulsion taken in one dose. 
If one close is not successful, try again the following morning. 
All tape worm remedies should be taken after a fast of twenty- 
four hours, and followed by an active cathartic. 

Quassia. — The infusion of quassia is a safe and effective 
remedy for pin or seat worms — ascarides vermiculares. It is in- 
jected into the rectum and held there several minutes. The ex- 
ternal parts must be washed with a very weak solution of carbolic 
acid at the same time (a half-teaspoonful of acid to the pint of 
water). 

MISCELLANEOUS. 

Arnica. — The tincture of arnica is prepared from the root of 
arnica montana, a mountain plant. It has obtained a wide reputa- 
tion for the relief of external bruises, strains and inflammations — ■ 
a reputation which it does not deserve. Its effects are largely due 
either to the rubbing which usually accompanies its application, 
or to the imagination, or to the alcohol of the tincture, which 
of itself is an excellent liniment. 



MA TERIA MEDIC A . 143 

Asafetida is an odorous gum which exudes from the root of 
an eastern tree. In Persia and other countries where it grows, 
the gum is used as a condiment with meats and other eatables. 
It is soluble in spirits, and ma}' be given that way, or in pill form. 
The dose is from two to five grains. Taken in moderate doses it 
aids digestion, and gently stimulates all the bodily functions. 
It is one of the best known remedies for flatulence or colic of in- 
fants, and is useful in cases of flatulence in adults. It also gives 
good results in infantile convulsions, and in hysteria, and other 
nervous affections. The old idea that it would ward off con- 
tagious diseases has no foundation. The germs of disease do not 
seem to be affected in the least by its horrible odor. 

Amy I Nitrite is an exceedingly volatile liquid, having in some 
degree the properties of nitro-glycerin. It is used by inhalation, 
and for this purpose is put up in fragile glass ''pearls," which may 
be crushed in the handkerchief and the drug thus inhaled. It 
often affords speed}- relief in spasmodic asthma and angina pec- 
toris. If taken at the first premonitory symptom, an epileptic con- 
vulsion may be averted. 

Alum is a crystalline substance with a bitter, astringent taste. 
In a dose of a teaspoonful, powdered, it is an emetic, safe and 
effective. It is useful as a gargle for sore mouth and throat, and, 
powdered, as an application to cuts and ulcers. Burned alum 
is a favorite home remedy for proud flesh in wounds and ulcers. 
A teaspoonful of the powdered alum in water will give relief in case 
of spasmodic croup, by exciting vomiting. Any other emetic will 
do the same thing, but alum is safe, and in most families is usually 
at hand. 

Bromide of Potassium. — The bromide of potash occurs in 
colorless cubical crystals, soluble in water. The dose is from 
fifteen grains to two drams. The principal use of the bromide is 
as a nerve sedative. It greatly lessens reflex irritability, slightly 
reduces sensibility to pain, and, in large doses, produces a feeling 
of drowsiness. Bromides are used for the relief of convulsions of 
all kinds, but especially for those of epilepsy. Some cases of 
epilepsy are cured by them. The bromides are also useful in in- 
somnia, delirium tremens, acute mania, congestive headache, 
tetanus, and strychnia poisoning. When their use is long con- 
tinued, there may be produced a condition of bromine poisoning, 
called brominism. The bromides of soda, ammonium, calcium, 



144 MA TERIA MEDIC A . 

lithium and strontium are all used with or in place of potash. 
They have similar effects. 

Belladonna. — The extract and tincture of belladonna and the 
sulphate of atropine are obtained from the plant commonly known 
as the deadly nightshade. Everyone knows its power of dilating* 
the pupil of the eye. Belladonna is an active poison. The medicinal 
dose of the tincture is from five to twenty drops ; of atropine from 
one-one hundred and twentieth to one- sixtieth of a grain. Bella- 
donna lessens the secretions of the glands. This is seen in the 
dryness of the mouth and throat following a dose. It may be 
given in cases of salivation, acute nasal catarrh with copious 
watery secretions, incontinence of urine, and night sweats. There 
is a long list of diseases which it is said to benefit, but, in most of 
them, it is unreliable. Externally, it is used in liniments and 
plasters. Stramonium (jimson) and hyoscyamus (henbane) re- 
semble belladonna in their actions and uses. 

Cerium Oxalate is an insoluble white powder; a salt of the 
metal cerium. It may take the place of bismuth, and is prin- 
cipally used as a remedy for vomiting. It restrains vomiting from 
various causes, but especially the vomiting of pregnancy. The 
dose is from two to five grains, usually given in pill form. 

Cocaine is an alkaloid derived from a South American plant — • 
the erythroxylon coca. It is used almost entirely as a local 
anesthetic. On mucous membranes, as of the eye, mouth and 
nose, it readily produces anesthesia by simple contact, but 
not so on the skin. There it must be introduced beneath the skin 
by a hypodermic syringe. Different solutions are used, varying in 
strength from one to four per cent. It should be remembered 
in using it that there is danger of forming the "cocaine habit," 
which is as serious as the morphine habit. 

Camphor is the gum of an eastern tree. Spirits of camphor 
is camphor gum dissolved in alcohol. Externally, it is a counter 
irritant, producing redness and heat. The powdered gum is an 
ingredient of most tooth powders. It is a mild nerve sedative, 
useful in nervousness, hysteria, mania, etc. Inhaled, it is a heart 
stimulant, useful in syncope or fainting, palpitation and threat- 
ened heart failure. 

Collodion is a syrupy liquid composed of ether, alcohol and 
gun cotton. When applied to the skin it produces a firm, protect- 
ing film. It is useful for covering abrasions, small cuts, wounds, 



MATERIA MEDIC A. 145 

etc. When first applied to a raw surface it smarts severely. 
A clean wound may be sealed with collodion and kept clean. 

CJiloroform is a colorless liquid of a pleasant ethereal odor 
and a sweet, burning taste. It dissolves many other drugs, oils, 
resins and fats. Used externally it is a counter irritant. It may 
be mixed with turpentine and sweet oil, or with camphor. Its 
principal use is as an anesthetic. It is more powerful than ether, 
but not quite as safe. The principal danger from chloroform is 
to the heart ; that from ether to the lungs. , 

Sulphuric Ether is a thin, colorless liquid with a characteris- 
tic odor and sweetish taste. The nitrous spirits of ether has al- 
ready been mentioned as a diuretic. Ether is mainly used as an 
anesthetic. It is dangerous to handle at night, for the reason 
that its vapor takes fire and burns readily. Both these drugs 
should be used only when administered by a physician. 

Dandelion. — The root of the dandelion has long had a pop- 
ular reputation as an agent of great medicinal virtues. It has 
been used as a home remedy and in many patent nostrums. 
Beyond being a mild tonic, it is worthless. 

Glycerin is a thick, syrupy liquid, having no odor and a 
sweetish taste. It is derived from animal fats by heat and pres- 
sure, and is soluble in water and alcohol. It is a weak antiseptic, 
and, as a rule, is not irritating to the skin, though it is with some 
persons. Applied to the tissues it abstracts Avater from them. 
Internally it has little effect, but is an excellent vehicle for a 
number of other remedies. It is useful as an application for 
chapped skin, inflamed membranes of the nose and throat, and 
as an injection in cases of constipation and dysentery. 

Iodide of Potassiujji. — The iodide of potash occurs in white 
crystals, soluble in water, and having a salty taste. The iodide 
of sodium and the iodide of ammonium are very similar to it. 
The dose of either is from two to ten grains, but more of the 
iodide of potash may be given, up to a dram. The principal 
action of the iodides is to increase the elimination of the waste 
products of the body. They are given in cirrhosis of the liver, 
asthma, chronic bronchitis, chronic pneumonia and pleurisy, en- 
largement of the liver and spleen, scrofula, syphilis and chronic 
rheumatism. 

Lithium is one of the rare metals. Its salts, but chiefly the 
carbonate and citrate, are used in medicine. The dose is from 
10 



146 MATERIA MEDIC A. 

two to ten grains. The carbonate is most used, is strongly 
alkaline, and renders the urine alkaline. It is beneficial in cases 
of rheumatism, especially in the chronic form, gout, the condition 
known as "the uric acid diathesis" and kidney stone. It may be 
advantageously combined with salicylate of sodium. 

Lead. — Salts of the metal lead are used as medicines, mostly 
as external applications. The solution of the subacetate of lead 
is most useful. It may be applied in cases of burns, eczema, 
erysipelas, ivy poisoning, nettle rash, herpes, or as an injection for 
inflammation of the urethra. Combined with a small amount of 
tincture of opium it is generally useful for relieving pain in external 
parts. 

Lobelia, or Indian Tobacco, is quite popular as a household 
remedy, and among certain herb doctors and quacks. Its prin- 
cipal action is as an emetic, for which purpose it is excelled by 
many other remedies. It is also a mild tonic, diuretic and cathartic. 
Its most important use is in the treatment of asthma. On the 
whole it is a drug which could easily be dispensed with. 

Opium is the dried juice of the unripe poppy. Powdered 
opium is a brown powder, having a bitter, nauseous taste. It 
depends for its strength on the morphine it contains. The 
tincture of opium is often called laudanum, and a tincture con- 
taining camphor and other drugs is much used under the name 
paregoric. Morphine is prepared from opium, and is about twelve 
times as strong as the powder. Codeine is another prep- 
aration, about one-fourth as powerful as morphine. The dose 
of laudanum is from ten to thirty drops ; of paregoric, from ten 
to sixty drops; of powdered opium, from one to four grains; of 
codeine, from one-fourth to one grain; and of morphine, from 
one-eighth to one-third of a grain. After taking opium for a 
length of time, a larger dose is required. Opium is a narcotic 
poison. The best antidotes are coffee, strychnia, atropine and 
physical exercise. The patient must be kept awake and in motion 
if possible. 

In small doses, opium stimulates the imagination, but not the 
reason or judgment. Its continued use renders the moral sense 
less acute. It depresses the heart and muscular powers, and less- 
ens the action of the glands and internal organs. Large doses 
produce a heavy sleep, followed by a stage of depression with 
headache, vertigo, nausea and mental confusion. The dreams of 



MATERIA MEDIC A. 147 

opium narcosis are vivid and pleasing. Opium lessens sensibility 
to pain of all kinds, and is the greatest of all anodynes. It is 
more effective for the relief of pain when injected beneath the 
skin. It is given in inflammations, neuralgia, sciatica, rheumatism, 
headache, melancholia, diarrhea, and a long list of other dis- 
eases. 

A\ hile opium is chiefly given to relieve pain, it is not true that 
it only blunts the perception of pain and is of no permanent 
aid. In many cases it is of real and lasting benefit. All opiates 
check the action of the bowels, codeine less than morphine. 
Opium is the best of all cough remedies, and codeine is, per- 
haps, the best of the opiates. In using opiates it is well to remem- 
ber the danger of forming the habit. 

Ox Bile, as its name implies, is the bile of the ox. It is 
purified and dried to about the consistency of tar. It may be 
given with benefit in cases of jaundice when the gall duct is 
obstructed. It is usually given in pill form, in doses of from two 
to three grains. It acts as an antiseptic and stimulates the action 
of the bowels. 

Pepsin is a natural ferment found in the human stomach. 
That used in medicine is prepared from the stomach of the hog 
and given when, owing to disease, the natural pepsin is not pro- 
duced in sufficient quantity. It is a yellowish gray powder, hav- 
ing a disagreeable odor and taste. The dose is from two to five 
grains. As to its efficiency there is some doubt. The dose of 
saccharated pepsin is from twenty grains to one dram. The liquid 
preparations are not as reliable. 

Pancreatin is a powder similar to pepsin in preparation and 
theory of use. It is prepared from the pancreases (sweetbreads) 
oi animals, and given to supply the want of the natural pancreatic 
juices, when, for any reason, they fail. It resembles pepsin in ap- 
pearance, but is odorless and has rather a pleasant taste. 

Silver Nitrate. — The nitrate of silver is used in medicine, 
both externally and internally. The dose is from one-eighth to 
one-half a grain. It is given for ulcer of the stomach, jaundice, 
cholera infantum, acute and chronic dysentery, ulcer of the rectum, 
and various diarrheas. 



148 MATERIA MEDIC A. 

WEIGHTS AND MEASURES. 

FLUID MEASURE. 

60 minims, 1 fluid dram, written 1 fl3 or :j. 

8 drams, 1 fluid ounce, written 1 fli or l]. 
16 fluid ounces, 1 pint, written 1 O, or Oj. 

8 pints, 1 gallon, written 1 C. or C-j. 

One minim of thin liquids is about equal to one drop. 

One dram equals an ordinary teaspoonful. 

Two drams equal an ordinary dessertspoonful. 

Four drams equal an ordinary tablespoonful. 

One ounce equals two ordinary tablespoonfuls. 

Two ounces equal an ordinary wineglassful. 

Four ounces equal an ordinary teacupful. 

Thick liquids cannot be measured by the drop or spoonful. 

APOTHECARY'S WEIGHTS. 

60 grains, 1 dram, written 13. 
8 drams, 1 ounce, written 1 3. 
12 ounces, 1 pound, written 1 lb. 

Grains, drams and ounces by weight cannot be measured by 
bulk. Most solid preparations are now put up in tablets, each 
containing an exact amount of a certain drug, thus affording 
an easy way to give preparations which cannot be measured 
without special instruments. Quinine may be measured by cap- 
sules; thus a No. 2 capsule will hold three grains; but as drugs 
vary greatly in weight, other powders cannot be measured with 
the quinine capsule. Although the No. 2 capsule holds three 
grains of quinine it will hold four of aloes, eight of bismuth, and 
still more of calomel. 

When possible, liquids should be measured in a small glass 
graduate, which may be procured of any druggist ; and solids 
should be given either in tablet form, or by weight. Otherwise 
there is no certainty as to the amount given. 

THE ADMINISTRATION OF MEDICINES. 

The dose of any medicine is the quantity of it which has been 
found through experience to be necessary to produce its cura- 
tive effects. It varies greatly in different individuals, and in the 
same individual under different circumstances. The principal 
conditions which modify the action of medicines and affect their 



MA TERIA MEDIC A . 149 

dosage are the age, weight, sex, habits and health of the individual, 
and the intervals between the doses. 

In general it may be stated that a smaller dose should be 
given 

To a child than to an adult ; 

To an aged person than to an adult between twenty-one and 
sixty : 

To a light person than to a heavy one ; 

To a weak person than to a strong one ; 

To a female than to a male ; 

To one living within doors than to one living in the open air. 

Most medicines give better results in small doses frequently 
repeated, than in large doses at long intervals, if in doubt as to 
the quantity required, give the smaller dose. Most drugs when 
used unnecessarily are liable to be injurious. 

Except in the department of "Diseases of Children," the 
doses indicated in this work, unless otherwise stated, are for ad- 
ults. Perhaps the best way to arrive at the proper close for a 
child is by a comparison of weights. Thus, if the child weigh 
one-third as much as the average adult, the average being about 
150 pounds, he will require one-third as large a dose ; if he be one- 
fifth as heavy he will require one-fifth the dose, and so on. A 
youth from 11 to 16 years of age usually requires from x to J 
the adult dose; and one from 17 to 20 years of age from § to f 
the adult dose. 

Another way of determining the size of the close for a child 
under thirteen } ears of age is found by the following rule : To the 
age of the child add 12, and by the sum thus obtained divide his 
age, the resulting fraction will show the part of the adult dose re- 
quired. Thus, for a child six years old we have ^ i i2=T 6 8 = i and 
the close is one-third that for the adult. In this way the following 
table has been prepared : 

To a child i year old give r V of the adult dose. 

2 years " 4- 

3 " " i " 

4 " " % " " " 

6 '• " Vx 



1 50 MA TERIA MEDIC A . 



80 " 90 " " " " y 2 

In general, but little medicine should be given to children, 
and, when given, should be in small doses frequently repeated ; 
never in large doses at long intervals. Don't be too free in the 
use of drugs. Both the patient and the physician are too prone 
to forget that the real cure must be wrought by the reparative en- 
ergies of the system, and that medicines should be given only at 
such times and in such quantities as will best assist nature in its 
combats with disease. 

MEDICINAL DOSE LIST. . 

Proper Name. Common Name. Preparation. Dose. 

Acetanilidum Acetanilide Crystals 2 to 15 grains. 

Acetic Acid Vinegar is impure ac. acid, Liquid 1 to 2 drams 

Arsenicum White Arsenic Powder ^ to ^ grain. 

Arsenicum Fowler's Solution Liquid 1 to 10 drops. 

Aconitia Aconite, Monkshood Tincture 2 to 10 drops. 

Alcohol Alcohol Liquid \ to 2 ounces. 

Aloes Aloes Extract \ to 6 grains. 

Alum Alum Crystals 10 to 15 grains. 

Ammonia Carbonate Am. Carb. Smelling Salts. Crystals 3 to 10 grains, 

Ammonia Chloride Sal Ammoniac Crystals 5 to 20 grains. 

Amyl Nitrite Amyl Nitrite Liquid Inhalation. 

Antimony Antimony Powder 2 to 6 grains. 

Antimony Tartrate Tartar Emetic Crystals \ to 2 grains. 

Anise Oil Anise Oil Oil 1 to 4 drops. 

Apomorphia Apomorphine Powder 2V to \ g ram - 

Aristol Aristol External Application. 

Arnica Leopard's Bane Tincture 1 to 2 drops. 

Assafoetida Assafoetida Gum 5 to 20 grains. 

Atropia Sulphate Atropine Crystals t -|q to ^ grain. 

Antipyrin Antipyrin Powder 3 to 20 grains. 

Balsam Peru Balsam of Peru Liquid 10 to 15 drops. 

Belladonna Deadly Nightshade Tincture 10 to 20 drops. 

Benzoic Acid Benzoic Acid Crystals 5 to 15 grains. 

Bismuth Subnitrate Bismuth Powder 5 to 20 grains. 

Bryonya Byrony Tincture .20 to 60 drops. 

Buchu Buchu Tincture 1 to 2 drams. 

Caffeina Caffeine Crystals. ....... 2 to 10 grains. 

Calamus Sweet Flag Tincture 1 to 2 drams. 

Calcium Chloride ....... .Chloride of Lime .Crystals 3 to 10 grains. 

Calomel Calomel Powder ^ to 10 grains. 

Camboge Gamboge Powder i to 3 grains. 

Camphor . . . ., Camphor Spirits 10 to 30 drops. 

Camphor Monobromate . . Camphor Crystals 2 to 10 grains. 

Cannabis Indica Indian Hemp, Hasheesh.. Tincture 5 to 20 drops. 



MATERIA MEDICA. 151 

Cantharis Cantharides, Spanish Fly. Tincture 5 to 20 drops. 

Capsicum Pepper Tincture 5 to 20 drops. 

Carboligni Charcoal Powder 1 o to 60 grains . 

Carbolic Acid Carbolic Acid Liquid 1 to 3 drops. 

Cardamon Cardamon Tincture | to 2 drams. 

Caryophylum Cloves Tincture \ to 1 dram. 

Caulophyllum Blue Cohosh Tincture 30 to 60 drops. 

Cascara Sagrada Cascara Fl. Extract 5 to 30 drops. 

Cascarilla Cascarilla Tincture I to 2 drams. 

Cerium Oxalate Cerium Oxalate Powder 1 to 10 grains. 

Cetraria Iceland Moss Decoction 2 to 3 grains. 

Chloranodyne Chloranodyne Liquid 5 to 15 drops. 

Chenopodium Worm Wood Powder 20 to 40 grains. 

Chionanthus Fringe Tree . .Fl. Extract .... 5 to 60 drops. 

Chloral Hydrate Chloral Crystals 5 to 60 grains. 

Chloroform Chloroform Liquid 3 to 10 drops. 

Cimicifuga Racemosa Black Cohosh Tincture 15 to 60 drops. 

Cinchona Bark Cinchona Bark Tincture 4- to 1 dram. 

Cinnamomum Cinnamon Bark Powder 3 to 10 grains. 

Cinnamomum Cinnamon Bark Tincture 1 to 2 drams. 

Citric Acid Citric Acid Crystals 10 to 30 grains. 

Coca Ery throxylon Coca Fl. Extract .... 1 to 2 drams. 

Cocaine Hydrochlorate. . .Cocaine Liquid i to 1 grain. 

Codeina Codeine i to 1 grain. 

Colchicum Meadow Saffron Tincture 15 to 30 drops. 

Cod Liver Oil Cod Liver Oil Oil -J- to 2 ounces. 

Colocynth. . , Bitter Cucumber.. . Extract 1 to 2 grains. 

Columba. . . Columbo Tincture i to 2 drams. 

Conium Poison Hemlock Extract 4 to S grains. 

Convallaria Lily of the Valley Tincture 10 to 20 drops. 

Copaiba Copaiba Balsam 20 to 30 drops. 

Copper Sulphate Blue Vitriol Crystals £ to 2 grains. 

Corn Silk ... .Corn Silk Fl. Extract 1 to 2 drams. 

Cornus Floridia. . . . Dogwood Fl. Extract i to 1 dram. 

Creasote Creasote Solution £ to 2 drops. 

Creolin Creolin External Only. 

Creta Praeparata Prepared Chalk Powder 20 to 60 grains. 

Croton Oil Croton Oil Oil . 1 to 3 drops. 

Cubebs Cubebs Powder 1 to 2 drams. 

Damiana Damiana Extract 1 to 5 grains. 

Digitalis Foxglove Tincture 2 to 10 drops. 

Disoscorea Wild Yam Fl. Extract , . . . . 5 to 20 drops. 

Dover's Powder Dover's Powder Powder 5 to 10 grains. 

Dulcamara Bittersweet Extract 5 to 10 grains. 

Elaterium Elaterium Powder ^ to i grains 

Ergota Ergot Fl. Extract 5 to 30 drops. 

Ergotinum Extract of Ergot Extract , . . 2 to 5 grains. 

Eucalyptol Eucalyptus Oil 1 to 5 drops. 

Euonymus . Wahoo Tincture 10 to 40 drops. 

Fel Bovis Ox Bile Liquid 5 to 10 grains. 

Ferri Chloridum Chloride of Iron Tincture 5 to 20 drops. 



152 MATERIA MEDIC A. 

Ferri Phosphas Phosphate of Iron Crystals 5 to 10 grains. 

Ferri Sulphas Sulphate of Iron Crystals . 3 to 5 grains. 

Galla Nut Galls Powder . 8 to 20 grains. 

Gaultheria Wintergreen Oil 1 to 2 drops. 

Gelsemium Yellow Jasmine Tincture 5 to 20 drops. 

Gentiana Gentian Comp. Tincture. | to 2 drams. 

Glycerinum Glycerine Liquid -J to 1 dram. 

Glycyrrhiza Liquorice Root Extract ^ to 1 dram. 

Granati Pomegranate Root Bark. .Powder 20 to 30 grains. 

Grindelia Robusta Grindelia, Nuttal Extract 2 to 4 grains. 

Guaiacol «. Guaiacol Fluid ^ to 2 drops. 

Guaiacum Guaiac Resin 10 to 30 grains. 

Haematoxylon Logwood Decoction 1 to 2 ounces. 

Hamamelis Witch Hazel. . . , Fl. Extract 2 to 5 drops. 

Helleborus Niger ., Black Hellebore Powder 5 to 10 grains. 

Helonias Helonias Compound Fl. Extract ^ to 1 dram. 

Hydrastis ; Golden Seal Tincture 20 to 60 drops. 

Hydrocyanic Acid Hydrocyanic Acid Dilute 2 to 8 drops. 

Hydrochloric Acid Muriatic Acid Dilute 10 to 30 drops. 

Hydriodic Acid Hydriodic Acid Syrup . , . 1 to 2 drams. 

Hydrangea Hydrangea Fl. Extract 10 to 30 drops. 

Hydrogen Peroxide Hydrogen Peroxide Liquid for external use. 

Hyoscyamus Henbane Tincture 10 to 30 drops. 

Ichthyol Ichthyol Semifluid 10 to 30 grains. 

Ignatia St. Ignatius' Bean Extract ^ to 1 grain. 

Iodoform Iodoform Powder for external use. 

Iodum Iodine , Tincture 5 to 20 drops. 

Ipecacuanha Ipecac Syrup 1 to 2 drams. 

Ipecacuanha Ipecac Powder 1 to 30 grains. 

Jaborandi Pilocarpine or Jaborandi. .Tincture 30 to 60 drops. 

Jalap Jalap Powder 2 to 30 grains. 

Juglans Walnut Leaves Decoction 1 to 2 ounces. 

Juniperus Juniper Oil 1 to 3 drops. 

Kola Kola Fluid Extract . . 10 to 30 drops. 

Leptandrin Leptandrin Resin 1 to 2 grains. 

Lithium Carbonate Carbonate of Lithium .... Powder 3 to 10 grains. 

Lobelia Indian Tobacco Tincture 10 to 30 drops. 

Magnesium Light Magnesia Powder 10 to 20 grains. 

Magnesium Sulphate Epsom Salts Crystals 1 to 4 drams. 

Male Fern Male Fern Oleo-Resin 10 to 20 drops. 

Marubium Horehound Infusion 1 to 2 ounces. 

Mentha Piperita Peppermint Oil 1 to 4 drops. 

" " Water .. 1 to 2 ounces. 

Menthol Menthol Crystals External use. 

Morphia Sulphate Morphine Powder i to % grain 

Morrhuse Oleum Cod Liver Oil Oil 1 to 8 drams. 

Myrrha Myrrh .Tincture 30 to 60 drops. 

Mass of Mercury ....... Blue Mass Mass 1 to 5 grains. 

Naphthol Beta Naphthol Powder 2 to 15 grains. 

Nitro Glycerine Nitro Glycerine Oil -^ to T ^ grain. 

Nitrate of Silver Nitrate of Silver Crystals r V to I grains. 



MATERIA MEDIC A. 153 

Nux Vomica Nux Vomica Tincture 10 to 20 drops. 

Opium, Camphorated . . . .Tincture Paregoric Tincture 15 to 60 drops. 

Opium, tincture Laudanum Tincture 5 to 30 drops. 

Opium, Powdered Opium Powder J to 1 grain. 

Pancreatin Pancreatin Powder 2 to 5 grains. 

Panax Ginseng Liquid £ to 1 dram. 

Pepsin Pepsin Powder 2 to 5 grains. 

Pennyroyal Pennyroyal Fluid Extract . . i to 2 drams. 

Petroleum Coal Oil Oil .... i to 1 dram. 

Phenacetine Phanacetine Powder . , 5 to ig grains. 

Phosphorus Phosphorus Solid ±1^ to T ^ grain . 

Physostigma Calabar Bean Powder 1 to 4 grains. 

Plumbum Subacetate Subacetate of Lead Solution External. 

Pine Compound Pine Compound Syrup 15 to 60 grains. 

Phytolacca Poke Root Powder 1 to 5 grains. 

Podophyllum .-May Apple, Mandrake.. . .Powder 10 to 20 grains. 

Potassium Acetate Acetate of Potash Crystals 10 to 20 grains. 

Potassium Bicarbonate . . . Saleratus Powder 10 to 40 grains. 

Potassium Bromide Bromide of Potash Crystals 5 to 60 grains. 

Potassium Chlorate Chlorate of Potash Crystals 5 to 20 grains. 

Potassium Citrate Citrate of Potash Powder 10 to 60 grains. 

Potassium Iodide Iodide of Potash Crystals 5 to 60 grains. 

Potassium Nitrate Saltpetre Crystals 5 to 30 grains. 

Potassium Permanganate.. Permanganate of Potash. .Crystals 1 to 2 grains. 

Potassium Tartrate, Acid. Cream of Tartar Powder i to 2 drams. 

Prunus Virginia, Cortex. .Wild Cherry Bark Syrup £ to 2 drams. 

Quinine Bisulphate Quinine Bisulphate Powder 5 to 40 grains. 

Quinine Sulphate Quinine Powder 2 to 30 grains. 

JResorcin Resorcin Crystals 5 to 10 grains. 

Rhei Radix Rheubarb Powder 2 to 20 grains. 

Ricini Oleum Castor Oil Oil £ to 2 ounces. 

Rutae Oleum Oil of Rue Oil 1 to 4 drops. 

Sabinae Sabine Oil 1 to 4 drops. 

Sabal Saw-Palmetto Fluid Extract . . 10 to 20 drops. 

Saccharum Lactis Sugar of Milk Powder 1 to 2 drams 

Salacinum Salacin Crystals 5 to 20 grains. 

Salicylic Acid Salicylic Acid Crystals 5 to 30 grains. 

Scammonium Scammony Resin 2 to 10 grains. 

Scilla Squills Syrup 30 to 60 drops. 

Scutellaria Scull Cap Fluid Extract . . 5 to 20 drops. 

Salol Salol Crystals 5 to 20 grains. • 

Sanguinaria Bloodroot Powder 1 to 20 grains. 

Santoninum Santonin Crystalline 2 to 5 grains. 

Senega Snakeroot Powder 1 to 20 grains. 

Senna Senna Infusion 1 to 2 ounces. 

Serpentaria Snakeweed Fluid Extract . . 10 to 20 drops. 

Soda Tartarata Rochelle Salts Powder £ to 4 drams. 

Sodium Benzoate Benzoate of Sodium Powder 10 to 30 grains. 

Sodium Bicarbonate Baking Soda Powder 5 to 20 grains. 

Sodium Bromide. .... ... Bromide of Soda Powder 10 to 30 grains. 

Sodium Hypophosphite. . .Hypophosphite of Soda. . .Powder 5 to 10 grains. 



154 MATERIA MEDIC A. 

Sodium Salicylate Salicylate of Soda Crystals 10 to 30 grains. 

Sodium Sulphate Glauber's Salts Powder -| to 1 ounce. 

Spiritus AetherisNitrosus. Sweet Spirits of Nitre. . . .Solution -J to 2 drams. 

Staphisagriae Stavesacre Seeds Oil £ to 2 drops. 

Stramonium Thornapple, Jimson Weed. Tincture 10 to 30 drops. 

Stropanthus Stropanthus Tincture 2 to 10 drops. 

Strychnia Strychnine Powder eV to iV g ram - 

Sulphonal Sulphonal Crystals 10 to 30 grains. 

Sulphur Sulphur Powder 20 to 60 grains. 

Stillingia Queen's Root Fluid Extract . . -£• to 1 dram. 

San tali Oleum Oil of Sandalwood Oil 10 to 20 drops. 

Sarsaparilla Sarsaparilla Liquid Extract . 2 to 4 drams. 

Tanacetum ... Tansy Oil 1 to 5 drops. 

Tanic Acid Tannin .... Powder 5 to 1 5 grains. 

Taraxicum Radix Dandelion Root Extract 5 to 15 grains. 

Turpentine Turpentine Oil or Spirits. . . 5 to 30 drops. 

Thymol . . Thymol Crystals External use. 

Toxicodendron Poison Oak Powder ... .... 1 to 3 grains. 

Trifolium Clover Syrup 1 to 2 drams. 

Triticum Repens Tritica, Couchgrass Liquid Extract . 1 to 2 drams. 

Tolu, Syrup Syrup of Tolu Syrup i to 2 drams. 

Thyroid Extract Thyroid Extract Powder 2 to 5 grains. 

Uva Ursi Bear Berry Leaves Infusion 1 to 2 ounces. 

Yerba Santa Syrup of Yerba Santa . . . .Syrup ..... ... 1 to 2 drams. 

Valerian Valerian Tincture ........ i to 1 dram. 

Veratrum Veride Green Hellebore. Tincture 5 to 20 drops. 

Virburnum Opulum Cramp Bark Fluid Extract . . 10 to 30 drops. 

Viburnum Prunifolium. . .Black Haw Liquid Extract . 10 to 30 drops. 

Vinum Wine Liquid i to 2 ounces 

Warburg's Tincture Warburg's Tincture Tincture £ to 1 dram. 

Xanthoxylum Prickly Ash Berries Fluid Extract . . 5 to 10 drops. 

Zincum Oxidum Oxide of Zinc Powder i to 5 grains. 



NURSING. 



mentioning 



By Robert S. Magee, M.D. 

As recovery of the patient often depends more upon the 
care he receives than upon the medicine he takes, the importance 
of good nursing can hardly be overestimated. Everyone should 
know of what it consists, for, although the care of the sick is a 
higher duty, a more responsible work, than can best be performed 
without special knowledge and experience, in the large majority 
of all cases the members of the family care for each other, so that 
to almost everyone, sooner or later, the call comes to act as nurse, 
and to women it is likely to come as an imperative demand. 

The Nurse. — Before 
her duties, 
a few words, applicable 
to all women while act- 
ing in this capacity, 
should be said of the 
nurse herself. The trained 
nurse of the hospitals 
wears a uniform consist- 
ing of a blue gingham 
dress, a large white apron, 
white linen collar and 
cuffs, or detachable white 
linen half-sleeves instead 
of cuffs, soft, heelless 
slippers, and a white In- 
dia linen cap, which is 
the badge of her profes- 
sion. At some hospitals 
pink gingham is worn, 
and at others white ging- 
ham, instead of the blue. 
While it is not ex- 
pected that others will don this costume, it is very desirable 
that every woman who performs the duties of nurse should so 

i55 




The Costume. 



156 NURSING. 

far imitate it as to wear aprons and dresses of soft, easily washed 
cotton or linen, and easy, quiet shoes. Rubber soled slippers 
are best for the sick-room, but if these cannot be obtained, the 
shoemaker will attach rubber heels to your every-day shoes, or 
you can yourself nail on small pieces of the sole of an old over- 
shoe, thus making them almost noiseless. The nurse should 
also pay such attention to her toilet as to be cleanly in person 
and dress, to have well brushed teeth and a sweet breath, and to 
be neat and tidy in her general appearance. Her nails should al- 
ways be closely cut and well brushed, and her hands be kept warm, 
soft and smooth. Cold cream, or glycerin, or a mixture of one 
part of glycerin and two of bay rum, well rubbed into the hands 
at night, will greatly aid in softening and keeping them in 
good order. 

A good nurse will have self-control, be calm in all em- 
ergencies, quiet and discreet, and maintain a cheerful, hopeful 
bearing. A peaceful but cheery atmosphere will prevail wherever 
she goes. She will engage in no discussions with the patient, or 
in his presence, and will allow no whispering in his room, or any 
thing else likely to excite or agitate him, but will try to secure to 
him repose of mind, as well as of body. As prolonged usefulness 
without health is impossible, she will care for herself as well as 
for her patient, and to this end will have a regular and proper 
diet, take an outing in the open air for an hour or two each day, 
and as far as possible have her regular hours of sleep. 

Good nursing includes the faithful execution of the phy- 
sician's orders, the personal care of the patient, attention to the 
cleanliness, temperature and ventilation of the sick-room, the 
control as far as may be of contagion and infection, an accurate 
reporting of the symptoms as they develop from day to day, and 
the proper preparation and administration of food. 

The Physician s Orders. — The nurse should make a time- 
table showing the hours for giving the medicines prescribed, also 
those for giving food, then as each is given check the hour with 
a small mark, drawing a line through those hours at which, for 
any reason, food or medicine was omitted, thus forming an ac- 
curate and useful record for the inspection of the physician. It 
is a singular weakness of human nature that leads very many 
ignorant people to feel called upon to give advice to the afflicted, 
no matter how serious the case, or how competent and skillful 



NURSING. 157 

the physician in charge. Many a patient has lost his life because 
of well-meant interference of friends. It is as clearly the duty 
of the nurse to guard the patient against all such dangers as to 
administer medicines and food, and it often requires much tact and 
gentle firmness to ward them off. 

Faithfully follow the directions of the physician, and, until 
his sanction has been obtained, permit the use of no additional 
remedies or foods, and substitute none, no matter by whom pro- 
posed. In many cases short calls may do the patient good ; in 
others even personal friends may have to be excluded. The 
nurse must see at all times that visiting is not carried to the point 
of fatigue, and never permit the rehearsal of harrowing or excit- 
ing tales or the announcement of deaths, or any other startling 
news in the sick-room. 

Personal Care. — Except in a few diseases, as spinal meningi- 
tis, in which the extreme nervousness of the patient requires the 
utmost quiet, it is of the first importance that the patient be kept 
clean. He must have 'a clean skin, clean clothes, clean air and 
clean surroundings." Y\ nether he wishes it or not, he should, as 
a rule, be thoroughly washed or sponged every morning with 
soap and water of the temperature most agreeable to him, and 
in the following order : - Face, ears, neck, hands, arms, chest, 
limbs, feet, back and abdomen. Take good care as soon as a part 
is washed to immediately and thoroughly dry it with a soft towel. 
Expose only the part that is being washed, or, if the air is chilly 
to the patient, do the sponging under cover of the blankets. The 
face and hands should also be washed every evening, and there 
should be such washing done at other times as occasion shall re- 
quire. The teeth should be cleaned each day with a brush or 
lint, and the hair should be carefully combed and brushed. No 
iron-clad rule can be given as to the frequency of changing the 
body and bed linen, but be generous in this regard. Nothing 
adds more to the comfort of the bed-ridden than fresh night- 
shirts, sheets and pillows, but always air and warm the clean 
changes, in another room, before placing them up©n the patient or 
his bed. 

To change the under sheet, remove all covers, except one 
blanket and the upper sheet, then draw out this sheet, leaving the 
blanket next the patient. Remove the pillow, turn the patient on 
his side near the middle of the bed, and fold the soiled sheet close 



158 NURSING. 

to his back; against this soiled sheet place a clean one half rolled, 
spread the unrolled part of it smoothly over the exposed part of 
the mattress, and firmly tuck it in ; then having turned the patient 
over on the clean sheet and removed the soiled one, unroll the 
clean sheet over the rest of the bed, draw it smoothly and tuck it 
firmly under the mattress. If the patient cannot be turned on his 
side, the sheet can be changed in a somewhat similar manner by 
working from the head to the foot of the bed. 

To change the tipper sheet, spread the clean sheet over the 
covering blanket, then, while holding the sheet with one hand, 
draw out the blanket, after which spread on the remaining bed 
clothes. 

The Draw-sheet . — A draw-sheet is formed by folding an or- 
dinary sheet crosswise into three or four thicknesses, placing it 
smoothly across the bed over the lower sheet so that it shall reach 
from the middle of the patient's back to his knees, and firmly 
tucking its ends under the mattress at both sides of the bed. 
When soiled it can easily be withdrawn and a new one substituted, 
an assistant lifting the patient a little if he is unable to raise him- 
self. 

Bed Sores. — Failure to keep the patient perfectly clean and 
dry, and to keep his bed dry and fresh, is the chief cause of bed 
sores. Besides taking great care to guard against these errors, 
the nates, back and hips should be examined daily in all cases of 
prolonged illness, and if any red spots are found, or there is com- 
plaint of any tenderness, after carefully washing and drying these 
parts, apply water and alcohol, water and vinegar, brandy, spirits 
of wine, or strong alum water, and, when the parts have dried, 
anoint them with olive oil, or vaseline, and having thoroughly 
rubbed it in, dust the parts with powdered boric acid, powdered 
oxide of zinc, or subnitrate of bismuth, or with powdered starch" 
if none of the others be at hand, and repeat this treatment every 
three hours until all signs of sores disappear. These serious afflic- 
tions can nearly always be avoided by this treatment if begun early 
and properly continued. In all cases of paralysis it should be 
begun very early, and before the appearance of any redness. Care 
must always be taken to keep the bed free from crumbs and every- 
thing that would irritate the skin. Let there be no wrinkles. 
Smoothness of the bed is more desirable than softness. Keep the 
sheet drawn snugly and its edges well tucked under the mattress. 



NURSING. 159 

The nurse will sometimes find a' bed sore when she first takes 
charge of a patient, in which case it is very important to heal 
it immediately. The following treatment, faithfully administered, 
will almost always cure : Wash the part with ether, apply to the 
sore a pad, about its size, of absorbent cotton saturated in gly- 
cerin, lay over it oil silk, and fasten it securely and smoothly with 
strips of adhesive plaster. Repeat this washing and dressing, at 
least twice daily. 

The Sick-room. — In every well arranged home there should 
be a room specially designed for the use of the sick. It should 
have a southern aspect, several windows arranged to open at both 
top and bottom, abundant sunlight, and an open grate, and be so 
arranged that it can easily be isolated from the rest of the house 
during a case of infectious disease. It will be a great advantage to 
have another well ventilated room opening into it, and near at 
hand on the same floor a lavatory and water closet with an out- 
side window. A water closet must never open directly into a sick- 
room, nor should such a room ever contain a stationary wash 
basin, sink or other sewer connection. The larger and more airy 
the room the better. It should be as far removed from the 
kitchen and living rooms as possible without fronting" on a noisy 
street, and, for greater safety in cases of infection or contagion, 
should be in the highest story of the house. Its floor should be 
one for use without carpets, its walls should be painted, or of a 
finish which can be washed; its woodwork plain and smooth, and 
without heavy moldings or cornices that would afford lodging 
places for dust. 

\^ciitilation. — To no other class is ventilation so important 
as to the sick, for, although weak and less able to overcome toxic 
influences, they must for days, weeks, or even for months, breathe 
only such air as they can get in their apartments, yet, how often 
Ave find the atmosphere of the sick-room extremely foul and every 
crevice tightly closed. Instead of such an atmosphere, reeking 
with poisons from his exhalations, excretions and bodily dis- 
charges, the patient should have air as pure as it is possible for 
painstaking intelligence to furnish. 

Pure air and cold air must not be confounded. Cold 
air from a hall or adjoining room is not what is needed, for such 
air may be very impure, but air from outdoors, as fresh and 
pure as can be obtained, and a gentle current of it should be kept 



160 NURSING. 

constantly flowing through the room. To this end, an outlet as 
well as inlet must be provided, for it is as important that impure 
air be carried out as that pure air be brought in. If care be taken 
to keep the patient from cold draughts, resort being made to 
screens or other devices, if necessary, to deflect the currents, there 
will be very little danger of his taking cold from the admission of 
outdoor air, even in midwinter. In connection with a window 
lowered a little from the top, a fire in an open grate makes a 
most excellent ventilator, and at the same time affords a safe 
means for the ready disposal of soiled dressings, cloths and other 
waste. When no fire is needed, a lighted lamp in the fireplace will 
heat the air sufficiently to create an upward current and serve a 
useful purpose. 

With all the advantages just outlined the nurse should have 
little difficulty in keeping the sick-room cheerful and healthy. In 
small, inconvenient houses, with close dark rooms, her skill and 
inventive ability will often be taxed to the utmost, but a clear 
and positive knowledge as to the importance of pure air and clean- 
liness will prove a large part of the battle. In most cases where 
there is a will there will be a way. 

Temperature. — It is not desirable that a patient who is cov- 
ered in bed should be kept in as warm an atmosphere as is often 
found in an ordinary sitting room, and many recommend 60 de- 
grees Fahrenheit as ideal for the sick-room, but as few nurses will 
feel safe in constantly remaining where it is so cold, we advise 
warmer air and lighter coverings for the patient. A thermometer 
should hang near the bed, and the temperature be kept as uniform 
as possible, care being taken that it shall not rise above 70 degrees. 
It should be remembered, too, that infants and old people require 
warmer air than others, that the room should be made warmer for 
bathing, and at the times when the patient leaves his bed, also 
that the temperature of the body is always lowest about three 
o'clock in the morning, and that there should be an extra blanket 
ready for use at that time. 

The careful nurse will always have hot water within easy 
reach for use in case of an emergency. It is best applied to cold feet, 
or other parts, when carefully sealed in fruit jars and wrapped suffi- 
ciently to guard against burning the patient, for, in many cases of 
paralysis or numbness, a patient may be seriously blistered with- 
out his knowing it. Jugs and well stoppered bottles are also used 
for this purpose. 



NURSING. 161 

Furniture. — Iron bedsteads, good coil springs, and smooth, 
firm mattresses of excelsior or cotton are the best for the sick, 
and probably no bed is worse for them than a feather bed. When 
practicable, it is best to have two beds, one for use through the 
day, the other for the night, thus admitting of thorough airing, 
but, in cold weather, care must be taken to warm the fresh bed 
each time before putting the patient into it. There should be a 
lounge and table, an easy chair and one or two cane bottom chairs, 
but no upholstery and no portieres, woolen hangings, or curtains 
except plain roller shades, of a green tint, and no carpets, unless 
a single strip or rug that can often be taken outdoors and well 
shaken and aired, be spread in front of the bed for the comfort of 
the nurse and to aid in securing perfect quiet. All woolens and 
upholstery retain dust and infections, thus becoming sources of 
danger. A portable screen is often useful, and may be improvised 
by spreading a sheet over a clothes-horse, or an easily made frame. 

The room should be made as cheerful as possible, and, except 
in cases of infectious diseases, pictures, with smooth frames that 
can be cleaned with a damp cloth, are almost a necessity; the 
same is true of potted plants, and cut flowers if kept in fresh 
water and removed as soon as they begin to dry and fade. Let 
everything be neat and tidy. No food, dishes, medicines, or medi- 
cal appurtenances, bed-pans, or similar vessels, should be left in 
sight of the patient. In cases of infectious diseases they can be 
placed behind a screen. In all other cases they should be brought 
into the sick-room only when wanted for immediate use, and be re- 
moved as soon as they have been used. The room can be well swept 
only when the patient has been removed from it, but with a damp 
cloth wrapped on a broom most of the dust can be wiped from 
the floor, and twice a week all the window sills, sashes and other 
projections should be wiped with damp cloths. 

Infectious Diseases are those caused by bacteria, or micro- 
scopic germs, disseminated without personal contact, direct or 
indirect. For the public safety, as well as for the protection of 
herself and the friends of the patient, it is very important that the 
nurse be so fully informed as to the nature of the disease in hand 
as to enable her the most effectually to checkmate its methods of 
spreading to others. 

As shown in the Department of Sanitation, the infectious dis- 
eases are of two great classes, the air-borne and the water-borne. 

11 



162 NURSING. 

The former class consists of those caused by genns which are car- 
ried in the air and, usually, first enter the system by being in- 
haled with the breath. Consumption, pneumonia, diphtheria, 
scarlet fever, yellow fever, small-pox, whooping cough, mumps, 
measles and influenza are of this class, and, although their germs 
differ widely as to virulence, and in their effects upon the body 
when they have found access to its tissues, we would in nearly 
all cases be safe from their ravages could the air we breathe be 
kept entirely free from them. 

To this end, a patient with any of these diseases should be 
promptly isolated and, to reduce to a minimum the danger from 
infection after his recovery, the sick-room before the patient en- 
ters it should be cleared of all unnecessary furnishings, especially 
of all upholstery and woolens, since they afford good refuges for 
bacteria, some of which are so tenacious of life as to be a menace 
for years, lying dormant until they chance to find their way into 
a human being, then multiplying with as great rapidity and viru- 
lence as had the opportunity occurred when they first left the 
patient in which they were formed. 

Ventilation must now be as perfect as possible, for the greater 
the dilution of the poison thrown off by the patient the better for 
him, and the less the danger to the nurse and to others, but special 
care must be taken that air from the sick-room shall not be blown 
into other parts of the house. As children have less power than 
adults to resist disease, they should be sent away. If the malady 
be one of the most serious, as scarlet fever or small-pox, there 
should be two nurses that, by relieving each other, each may 
have a few hours daily in the open air, and neither be obliged 
to sleep in the same room as the patient. Only the physician 
and nurses should have access to the room, and, as far as pos- 
sible, all communication between it and the rest of the house 
should be cut off. 

The nurse should wear only such clothing as can be boiled 
and washed, unless it is to be burned as soon as she is through 
with the case, for the danger from carrying such diseases in 
clothing is very great. As the hair of the nurse is also a source 
of much peril, she should wear over it a closely fitting cap, and 
wash the hair thoroughly in a strong disinfectant, such as one 
part of formalin in twenty parts of water, each time before min- 
gling with other people. After carefully washing, and changing to 



NURSING. 163 

clean clothing kept in another room, she should take a brisk 
walk in the open air each day, nor should fatigue, or the dread of 
making the preparations, deter her from a faithful observance 
of these precautions for preserving her own health and efficiency. 

The broom, brushes, cloths, etc.. used, must not be taken 
from the room until the quarantine is over, and must then be 
burned. The dishes used should be kept in the room; in fact, 
nothing should be removed after the patient enters, unless it be 
immediately disinfected. The soiled clothing of the patient and 
nurse, and all bedding that requires washing, should be carried 
from the room in a tight bag and thrown, bag and all, into boil- 
ing water and boiled half an hour before it is sent to the wash. 
For the management of the sputa and nasal discharges of such 
patients, see Department of Disinfection and Disinfectants. 

The bedsteads and all other furniture, floor, walls and wood- 
work should be wiped carefully twice a week with cloths wet in 
some disinfectant. A i: 1,000 bichloride of mercury solution (fif- 
teen grains of the bichloride to a quart of water) is probably the 
best for this purpose ; but a 1 :20 solution of carbolic acid, or a 
two per cent solution of formaldehyde, will do. It must not be for- 
gotten that these substances are poisonous and require careful 
handling, and that if bichloride or carbolic acid solutions are used 
upon the skin they must be applied only to small surfaces at one 
time, because of the danger from absorption. Sheets, or other 
large cloths, should be hung in various parts of the room, espe- 
cially over the door, and be kept wet in the disinfecting solution. 
This precaution is important, partly because of the real good that 
it does, and partly because of its influence in reassuring the family 
and neighbors that the disease will thus be prevented from spread- 
ing. 

The wonderful power of the mind over the body is often 
very clearly seen during epidemics, and no one can overestimate 
the services of the calm, cheerful nurse who, discerning be- 
tween real and imaginary dangers, dispels false alarms and en- 
courages hope. An intelligent comprehension of the situation is 
now valuable beyond measure. Depression, anxiety and fright 
invite disease by deranging the system and rendering it less able 
to resist, and many have died at such times simply from the stress 
of ignorant fear. Having taken every proper precaution, an in- 
dividual is safer for keeping the mind occupied with healthful 



164 NURSING. 

themes and, as far as may be, pursuing his ordinary business rou- 
tine. 

Water-borne diseases are those caused by bacteria which 
are usually carried into the stomach of the patient in his drink, 
but sometimes are introduced with the food and, rarely, in other 
ways. Typhoid fever, malarial fever, cholera, and some of the 
diarrheas, are the principal examples of this class. In these 
diseases isolation of the patient is not necessary, for instead of 
being thrown off in the breath, or in eruptions or excretions 
of the skin, their bacteria are carried out in the excreta. The 
dissemination of these diseases is, therefore, prevented by thor- 
oughly disinfecting all the discharges from the bowels, also all 
cloths and clothing used about the patient, and by keeping him 
clean. 

A pint of strong disinfecting fluid, such as the bichloride 
or carbolic solution, should be kept standing in the vessel which 
receives the stools of the patient. 

Never throw such stools into the common water closet, lest 
their disinfection may have been imperfect. A safe and con- 
venient disposition of them is afforded by a trench or pit three 
or four feet deep, if each time dejections are thrown in they are 
immediately and thoroughly covered with fine dirt, and, when 
the pit. is thus filled to within eighteen inches of the top, it is 
shoveled full of fresh earth, a new one being dug for further use ; 
but let it be remembered that such an arrangement must never 
be less than 100 feet from any well or cistern, or other source 
of water supply, or where the drainage is toward such supply, and 
in case the soil or underlying stratum is of sandy formation, the 
pit must be much more than ioo feet away. 

As flies often contaminate food with disease germs brought 
on their feet from excreta over which they have walked, it is 
very important that they never be allowed access to such sources 
of danger. For the disinfection of clothing nothing is better 
than steady boiling for thirty minutes. All soiled cloths and 
dressings should be burned. For the treatment of nasal dis- 
charges, sputa, and excreta, see the Department of Disinfection 
and Disinfectants. 

Contagions Diseases. — Like the air and water-borne diseases, 
contagious diseases are due to germs, but to germs which are 
communicated from one person to another only through contact, 



NURSING. 165 

either direct or indirect. Itch, syphilis and gonorrhea are dis- 
eases of this class. Safety lies in destroying their germs as 
far as possible by such agents as the bichloride of mercury, and 
in touching the affected parts of the patient, or anything with 
which they have been in contact, only when absolutely necessary, 
and then immediately washing the hands in strong disinfectants 
to destroy or get rid of the bacteria that may have adhered to 
them. If soap is used for this purpose, the variety known as 
green soap, saponis viridis, specially prepared by druggists, is 
best, and the next best is the old-fashioned soft soap, made from 
grease and the lye of wood ashes, either being safer, because 
far more efficient as a cleanser and germicide, than any toilet 
or laundry soap. The same precautions as required in infec- 
tious diseases should be taken Avith the soiled bedding, cloths 
and clothing. The danger from handling gonorrheal clothing, 
then rubbing the eyes with the hands, is very great. Innocent 
laundresses have thus been made incurably blind in one week. 
Proper disinfection of the clothing before sending it to the wash 
would have prevented this possibility. 

As to the management of the room and its contents at the 
conclusion of an infectious or contagious case, see Department 
of Disinfection and Disinfectants. 

Corpses. — In case of death in the city, the undertaker will 
take immediate charge of the body, the sooner the better, but 
in remote country districts, it is necessary to prepare the body 
for burial before such aid can arrive, and in infectious cases 
this duty will devolve upon the nurse. In all cases the body 
should be washed in one of the disinfecting solutions and imme- 
diately placed upon its back on a wide board seven or eight feet 
long, the head end being raised about two feet higher than the 
feet, as by placing the one end in a chair and the other on the 
floor, that the blood, before coagulating, shall settle into the 
lower parts, thus preserving the natural color of the face, ears 
and neck (instead of permitting the purple or almost black dis- 
coloration often mistaken for immediate putrefaction), and add- 
ing from six to twelve hours to the time the body can be kept 
in gt)od condition. Wet in the disinfectant a handful of cotton 
and place it under the buttocks, straighten the limbs, bind the 
feet together, fold the hands across the breast, hold the lower 
jaw in place by a snug bandage about the chin and head (the 



166 NURSING. 

jaws are likely to become fixed within forty-five minutes after 
death), and close the lips and eyes, gently placing small pieces 
of cotton, wet in the solution, over the eyelids with very little 
pressure. The quite common practice of using coins for this 
purpose should never be permitted, for they almost always dis- 
tort the features by flattening the eyeballs. Cover the face with 
several thicknesses of cloth wet in the solution, spread a sheet, 
wet in the same, over the body and secure thorough ventilation, 
then thoroughly cleanse your own person and don a clean change 
of clothes. 

Although it is the duty of the physician, when a patient has 
died of an infectious disease, to prohibit a public funeral, the 
nurse should also understand the great importance of this pre- 
caution, and never hesitate to use her influence on the side of 
safety. 

The Observation of Symptoms. — The temperature of a 
healthy body changes very little, remaining at about 98.4 Fahren- 
heit whether in summer or winter, but in disease it may vary quite 
a number of degrees, and as these variations form important 
diagnostic symptoms they should be carefully reported by the 
nurse. A clinical thermometer, designed for this purpose, can 
be purchased at the drug store, and is a necessary part of the 
nurse's equipment. To ascertain the temperature, this instru- 
ment should be placed under the tongue of the patient and held 
there, the lips being kept closed, for three to five minutes, the 
nurse then carefully noting the point registered, after which the 
thermometer should be thoroughly cleansed. If the patient is 
unable to take the instrument in his mouth, it may be placed 
in his armpit, and the arm drawn down snugly by his side, or 
it may be anointed with vaseline or oil and inserted about an 
inch and a half into the rectum, and left there the required time. 
The rectal temperature is usually a little higher than that of the 
mouth and is more reliable. 

The Pulse is ascertained by counting the beats of the radial 
artery, in the wrist just above the thumb, for one minute by 
the watch. The nurse should cultivate the ability to correctly 
observe all the symptoms of the patient, for if this be done fully 
and accurately from day to clay, it will greatly aid the physician 
in prescribing the proper treatment. It is better to make this 
report in writing, and it should cover the following points : 

Temperature and state of pulse at certain hours. 



NURSING. 167 

Bowels, number of movements, at what time and of what 
character. 

Sleep, number of hours and of what quality. 

Special symptoms, as vomiting, nausea, headache, etc., and 
the time of the occurrence of each. 

The Preparation of Foods. — Cooking, in the broadest sense, 
is the palatable preparation of all articles of diet ; but in its usual 
sense means the subjection of food to the action of heat ; as by 
steaming, boiling, baking, roasting, broiling, either to render it 
palatable or digestible, or both. Cooking also destroys or ren- 
ders harmless many of the poisons with which foods are some- 
times contaminated. 

Very different temperatures are required for the proper 
preparation of different kinds of food. The greatest heat to 
which eggs should ever be subjected is 160 degrees F., since 
at that point their albumen coagulates, is tender, and becomes 
palatable and the most easily digestible, but, if heated beyond 
this point, in proportion to the degree applied, becomes tough 
and indigestible. Thus, in the so-called "soft boiled" egg, i. e.. 
one that has been kept a short time in water at 212 degrees, 
there is a tough layer next the shell, and a soft digestible center; 
but the "hard boiled" egg, one that has remained in the water 
until every part of it has undergone the action of the boiling 
temperature, is all tough, and hard to digest; and an egg cooked 
in a temperature of 400 degrees becomes so tough and hard 
as to be good marble cement, but wholly unfit for food. 

Soft Boiled Eggs. — To prepare soft eggs for the sick, since 
it is difficult to maintain an even temperature of 160 degrees, 
place them in a basin on a part of the stove that has but little 
warmth, pour over them boiling water, a pint for each egg, 
and leave them uncovered eight minutes. 

To Poach Eggs. — Let a basin of water come to a simmer- 
ing heat, never to the boiling point, add a teaspoonful of salt, 
carefully break in the eggs, dip the water over them until the 
whites are firm and films form over the yolks, remove with a 
skimmer, add a little butter to each, salt and pepper to the taste, 
and serve while hot. 

Fried Eggs. — Like every other kind of fried food, fried eggs 
are unfit for the sick. 

To Cook Starchy Foods. — To properly cook starch requires 



168 NURSING. 

a great deal of heat, for the object now to be attained is the 
bursting of the woody envelope covering each individual gran- 
ule, thus setting free its elements, that, when eaten, they can be 
readily acted upon by the saliva — the fluid which digests starch 
by changing it into sugar. Starch itself will not pass through 
the membrane lining the alimentary canal, into the blood, and 
has to undergo this chemical change into sugar before its ingre- 
dients can be absorbed. Hence, the importance of well-baked 
bread, well-cooked potatoes, in fact, of all starchy foods being 
cooked so long and well as to thoroughly break up all their gran- 
ules. Indeed, unless well cooked, a large portion of such food 
passes through the body unchanged, doing a healthy person no 
good, a sick one positive harm. Because of the greater heat 
obtained in the roasting process, a roasted potato is more easily 
digested than a boiled one. The more easily digestible a food 
can be made the better, and this end should always be especially 
sought in cooking for the sick. 

Diet in Disease. — In disease the diet should, of course, be 
restricted. In this the appetite of the patient is usually, but 
not always, a safe guide. In apathetic states, as of typhoid, the 
attendant should not wait until the patient calls for food or drink, 
and in such diseases as consumption, more than the appetite de- 
mands may be eaten with benefit. On the other hand, in con- 
valescence from fevers and other wasting diseases, the nurse must 
see that the patient does not eat too much, and be slow in increas- 
ing the food. She must also be slow in changing from a liquid 
to a solid diet, and in so doing be extremely careful, for the first 
day or two, giving, besides the liquid, only a piece of buttered 
toast as large as the two fingers, with a little tea or cocoa, every 
three hours; and she must carefully guard the patient from get- 
ting food at any other time, since the craving for nourishment 
is likely to be so great as to quite overcome his judgment, and 
the condition of the system such that even a little of seemingly 
harmless food might cost him his life. 

Fevers and Inflammations. — The best food in these cases, 
as well as in many others, is milk. If it irritates the stomach, 
it should be scalded, or diluted with one-third its bulk of lime- 
water, or, what is often much better, should be peptonized (by 
which we mean the addition of artificial pepsin to the milk, thus 
producing a change before it is taken that naturally occurs after 



NURSING. 169 

it reaches the stomach). Pepsin tubes with full directions can 
be bought at any drug store. Milk alone will sustain life indefi- 
nitely. It is especially suitable food in typhoid and scarlet fevers, 
and may be given there alone. It should not be gulped down 
in large quantities, but sipped or eaten slowly with a spoon, 
since, if taken too rapidly to mix with the digestive juices, a curd 
is likely to form upon the outside of the mass, in which condition 
it may lie in the stomach for hours as a plastic, indigestible ball. 
If properly administered, neither beef teas nor extracts are so 
useful, or as easily digested, but beef tea must sometimes be given 
as the next best resort. 

Beef Tea. — As often prepared, beef tea is worthless as an 
article of diet. Bartholow gives the following recipe for its 
proper preparation : "A pound of lean beef should be freed from 
all bone, cartilage, fat, tendon, vessels and refuse of every kind; 
chopped fine, and digested for two hours in a pint of cold water. 
It should then simmer, but not boil, on the stove for three hours, 
cold water being added if necessary to keep the amount up to 
a pint. It should then be strained, and the beef pressed. Two 
ounces of this liquid every three hours is a suitable quantity for 
an adult." 

Beef Juice. — The various beef extracts put up by the large 
packing companies and other firms are nutritious and useful, 
but inferior to fresh beef juice. Other meat juices are also in- 
ferior. Chicken broth ranks next to beef, and then comes that of 
veal. A good method of preparing beef juice is as follows : 
"Select a good piece of round steak, free it from all fat, refuse, 
etc., season to the taste and broil slightly on both sides in a 
hot skillet, then press out the juice with a meat press or lemon 
squeezer. Give from two teaspoonfuls to two tablespoonfuls, 
according to the condition of the patient, once in three hours. It 
should be remembered, however, that beef juice is more of a 
stimulant than it is a food, because so difficult of digestion as to 
really be of little value in many cases. If it nauseates the patient, 
it should be frozen like ice cream, in which form it is very palat- 
able. 

Barley Water and egg-nog are other foods. To prepare bar- 
ley water: "Wash two ounces of pearl barley, add fresh water, 
boil five minutes, and pour off the water; then pour on two quarts 
of boiling water, and boil down to one quart. Flavor to the taste, 
but do not strain." 



170 NURSING. 

Egg-nog. — ''Scald some milk and let it cool; beat up a fresh 
egg with granulated sugar in a tumbler ; and having beaten it to 
a froth, add a dessertspoonful of brandy, and fill up with milk." 

Egg-nog. — Separate the egg, and whip up the yolk with a 
teaspoonful of sugar and about a third of a glass of milk or cream ; 
the latter is better because more digestible; then beat in from 
a teaspoonful to two ounces of whisky, or leave out the whisky 
and flavor with lemon or vanilla if preferred ; whip the white 
separately and place it on the other, grate a little nutmeg on top 
and serve immediately. An egg-nog should not be allowed to 
stand after it is made, since the egg and milk both lose some 
of their freshness by exposure to the air. 

Milk PitncJi. — Into a cup of milk, sweetened with a teaspoon- 
ful of sugar, stir two tablespoonfuls of brandy and pour from 
glass to glass, or shake in a lemonade shaker, to thoroughly mix, 
then grate a little nutmeg on top and serve. 

Some prefer to cool a cup of milk with cracked or shaved ice 
and add enough sugar to make it quite sweet ; shake to a good 
foam in a lemonade shaker, add two tablespoonfuls of brandy and 
one or two teaspoonfuls of Jamaica rum, and serve while cold. 

Milk Lemonade. — Into one-fourth cup each of lemon juice 
and sherry and one tablespoonful of sugar, pour a cup of boiling 
water, stir thoroughly, then add one and a fourth cups of milk, 
•stir until curdled, strain through linen, and cool by placing on ice. 

In Wasting Diseases. — In wasting diseases, as cancer or con- 
sumption, both classes of foods are required, the proteids to re- 
place the rapidly disappearing tissues, and fats and starches to 
maintain waning strength. The fats are more valuable here than 
the starches and sugars, because more readily assimilated. Those 
most useful are fat meats (except pork), butter, cream and olive 
oil. Cod liver oil is also very useful, for although a medicine it is 
also a food.' In these conditions the malt liquors may also be 
given to advantage, but they are of more benefit in aiding diges- 
tion and assimilation than they are as foods. They have a peculiar 
power of converting starches and sugars into fats. In these dis- 
eases the quantity of food should be large, more than the appetite 
demands. 

In Diseases of the Stomach and Bowels. — In these diseases 
the least amount of food consistent with strength should be taken. 
In severe acute cases it is often well to withhold all food for forty- 



NURSING. 171 

eight hours, and in some cases it is necessary to resort to rectal 
feeding — an excellent way of supplying nourishment and keeping 
up the strength of the patient when, because of stomach irritabil- 
ity, he is unable to retain food taken by the mouth. It should 
begin early in acute diseases, but only when advised by a phy- 
sician. It is done by injecting into the rectum predigested food, 
as peptonized milk, an egg beaten up in peptonized milk, or some 
other easily digested liquid food, by means of a syringe. It may 
be repeated once in four hours. The hips should be raised a little 
to assist the patient in retaining it, and once or twice each day, 
shortly before a feeding, the bowel should be cleansed by an in- 
jection of soap and water. Of course, rectal feeding is never to 
be administered in rectal diseases. In diseases of the stomach, 
starches may be given since they are digested in the intestines ; 
but in diseases of the intestines give proteids for they are mostly 
digested in the stomach. Scalded milk, milk and lime water, or 
better milk and pepsin, lemonade, barley water and albumen water 
may be given. 

Albumen Water or Egg Water is prepared as follows : "To the 
white of one fresh egg add half a pint of cold water previously 
boiled, a little sugar and one teaspoonful of brandy ; shake thor- 
oughly and feed cold." It is a very useful food in the digestive 
troubles of infants. In these cases milk is not as good a food and 
it should be peptonized. Of milks, the human milk is best, and 
cows' milk is next. Condensed milk and the many varieties of 
"Infant's Food" on the market are all inferior. Although in- 
fants reared on them often look fat and hearty, they are not really 
strong, and readily succumb to diarrheas and other diseases. 

Miscellaneous. — In diabetes all sugars and starches should 
be avoided as the plague. The diet must consist of the proteids. 

Diseases of the liver and kidneys, as a rule, are benefited by a 
liquid diet. Milk is superior here to all other articles, and skimmed 
milk is often better than new milk. 

Patients suffering from scurvy, as is well known, rapidly im- 
prove on a diet which includes fresh vegetables. 

In rickets the food should contain lime and other minerals. 
Unbolted wheat flour and oatmeal contain these elements in 
comparatively large proportions. 

In rheumatism, gout, and similar diseases, vegetables and 



172 NURSING. 

acid fruits are beneficial. Animal foods and sweet substances 
should be avoided. 

Constipation can usually be overcome by proper food. Oils, 
fats, bulky foods, fruits and vegetables are the diet for such cases. 

Patients suffering from scrofula, continued suppuration and 
joint disease should have a plentiful diet, including unbolted 
flours and meals, both lean and fat meats, cod liver oil, cocoa, milk 
and eggs. 

Nursing mothers who do not furnish sufficient milk should 
drink milk, cocoa and beer, and eat fatty and oily foods. 

The Administration of Food. — Let there be nothing luke- 
warm. Serve hot foods hot, and cold foods cold. They should 
be clean, daintily prepared, and brought promptly at the time 
prescribed. Give the patient all the time he wants that he may 
eat slowly, but as soon as he has finished, remove all dishes and 
remnants to avoid unpleasant sights and odors. Never ask a 
sick person what he wants to eat. If he calls for a certain kind of 
food, and the physician consents, give it the preference in prepar- 
ing his meal, otherwise, try to make each bill of fare a surprise 
to him, and so change it from day to day as to give variety and 
relish. 

BILLS OF FARE FOR TFIE CONVALESCENT. 

Since personal tastes differ greatly, especially in the sick, it 
is often extremely difficult to prescribe a diet that shall be palatable 
and at the same time best for the patient, but the bill of fare must 
contain only such articles as are nutritious and easily digestible, 
even though abnormal cravings have to be restrained. The fol- 
lowing outline may serve as a guide for a week during con- 
valescence and, with such variations as will be likely to suggest 
themselves to the nurse, may be a help thereafter. Due care must, 
of course, always be taken not to give any article of food contra- 
indicated by the patient's disease. 

FIRST DAY. 

Breakfast. — Beef broth with bread crumbs. 

Lunch. — Egg-nog. 

Dinner. — Raw oysters ; crackers and butter ; a glass of sherry. 

Lunch. — Hot beef tea. 

Supper. — Cream toast; jelly; cocoa. 



NURSING. 173 

SECOND DAY. 
Breakfast. — Granose with sugar and cream ; cup of chocolate. 
Lunch. — Glass of milk. 

Dinner. — Small piece of broiled bass or crappie ; a baked 
Irish potato ; bread and butter. 

Lunch. — Cup of custard with cream. 
Supper. — Milk toast; jelly; tea. 

THIRD DAY. 
Breakfast. — Poached egg; bread and butter; coffee. 
Lunch. — Egg-nog. 

Dinner. — Mutton soup ; tender sweet breads ; whipped cream ; 
light wine. 

Lunch. — Beef tea. 

Supper. — Raw oysters ; bread and butter ; chocolate. 

FOURTH DAY. 
Breakfast.' — Oatmeal with sugar and cream; lamb chop; 
cream potatoes; bread and butter; coffee. 
Lunch. — Glass of milk. 

Dinner. — Chicken soup ; baked potato ; bread ; tapioca cream. 
Lunch. — Custard with cream. 
Supper. — Buttered toast; currant jelly; wafers; cocoa. 

FIFTH DAY. 

Breakfast. — An orange; soft boiled egg; wheat germ, with 
sugar and cream; soft buttered toast; coffee. 

Lunch. — Hot beef tea. 

Dinner. — Mutton soup; small rare piece of tender steak; 
baked potato ; rice pudding ; bread. 

Lunch. — Milk punch. 

Supper. — Calf's foot jelly; raw oysters; bread and butter; tea. 

SIXTH DAY. 

Breakfast. — Granose with sugar and cream ; poached eggs on 
toast; coffee. 

Lunch. — Chicken broth with crackers. 

Dinner. — Beef soup; small piece of breast of roast chicken; 
baked potato ; whipped cream ; bread. 

Lunch. — Glass of milk. 

Supper. — Baked apples ; raw oysters ; bread and butter ; grape 
jelly; cocoa. 



174 • NURSING. 

SEVENTH DAY. 

Breakfast. — An orange; oatmeal and cream; scrambled egg: 
buttered toast ; coffee. 

Lunch. — Hot beef tea. 

Dinner. — Chicken soup; a little tender roast beef; creamed 
potatoes; tapioca pudding; bread. 

Lunch. — Cup of custard. 

Supper. — Sponge cake with cream; buttered toast; apple 
jelly; tea. 



EMERGENCIES. 

By Louis C. Duncan, M.D. 

CHAPTER I. 

POISONING. 

Knowledge of poisons is older than history. ' The first peo- 
ple known to have used them were the Egyptians, who probably 
obtained the basis of their knowledge from the Chaldeans. The 
Chinese and Hindus were acquainted with them as early as 900 
B. C. ; and among the Greeks, and other contemporaneous peo- 
ples, they were so often used that it was customary for cup-bear- 
ers to taste beverages in his presence before presenting them to 
the king. The death of Socrates by hemlock in 339 B. C is known 
by every school boy, and in Rome also poisons were much used 
as a means of getting rid of obnoxious persons. 

During the middle ages the study of poisons was ignored ; 
partly because it was not an age of study, and partly because the 
dagger and ax were weapons better suited to the boid spirits 
of the time ; for, be it remembered, poisons in those days were not 
employed for the healing of disease, but were used as poisons only, 
either to rid one of his enemies or to rid himself of the incubus of 
life when it had become no longer endurable. 

In ancient times life was thought to be a mysterious some- 
thing which inhabited the body, and took flight on the entrance of 
another mysterious something called a poison, but if still another 
mysterious something, called an antidote, could be introduced in 
time, the poison might be thwarted and life remain. The same 
idea prevailed in regard to all diseases; they were entities in some 
way to be driven out. If these views are held by any now, let us say 
that there is no more mystery about disease and poisons than 
about paint wearing off a house, shingles blowing from a roof, or 
rats gnawing holes through partitions ; and there is no more mys- 
tery about antidotes and other curatives than there is about re- 
pairing the house with paint, shingles and plaster. 

With the advent of reason and logic in the study of physi- 

175 



176 EMERGENCIES. 

ology and medicine, came a gradual change in our views of life, 
disease and death. From patient investigation, by thousands of 
scientific men, it has been learned that poisons do not act in a 
mysterious way, but in a very certain and definite manner, which 
may be known and as certainly counteracted. When the physical 
life ceases it does so from a cause ; some part fails. For example : 
A person takes a poisonous dose of aconite ; perhaps a teaspoonful 
of the tincture. If he receives no aid his life will soon be ex- 
tinguished, not in a mysterious way, but because aconite weakens 
and slows the heart until it is stopped. Now what could be more 
simple or logical than to give this patient something, as strychnia, 
that will stimulate the heart and keep it going until the body elimi- 
nates the aconite? And so, although there is a legion of them, 
by careful study and experiment, an antidote has been found for 
every poison. 

Taking the word in its broadest sense, there are three classes 
of antidotes : First — The remedies or means of getting the 
poison out of the body ; such as the stomach tube, emetics, phys- 
ics, etc. 

Second — The chemical antidotes — drugs which unite with 
the poison, while yet in the stomach and render it harmless. Thus, 
in case an alkali has been swallowed, an acid may be given as a 
chemical antidote. 

Third — The physiological antidotes — the drugs or measures 
which have the opposite effect on the functions of the body from 
that of the poison, an example of which is given above. 

MODERN USES OF POISONS. 

Formerly poisons were used as poisons only, but to-day the 
most deadly of them are used in the arts and sciences, as medicines, 
and in the affairs of every-day life. Consequently we have a large 
number of accidental poisonings; in fact, they exceed all others. 
It should be remembered that many of the well known drugs are 
poisonous, if taken in quantities larger than the medicinal dose. 

Some physicians, using vegetable remedies exclusively, strive 
to inculcate the idea that minerals are poisonous and that vege- 
tables are not, merely to advance their own merits at the expense 
of those employing all remedies of known virtue, no matter from 
what kingdom they have come. To refute the fallacy it is only 
necessary to mention such vegetable remedies as aconite, strych- 



EMERGEXCIES. 17 ? 

nia, belladonna, opium and conium, each a poison of well known 
power, and that most deadly of all common poisons, hydrocyanic 
acid, found in the kernels and leaves of the ordinary peach tree. 

A person may be poisoned in a variety of ways. 

First. — By swallowing some poisonous substance. This is 
the most frequent. 

Second. — By inhaling a poison, such as illuminating gas 
which annually numbers its victims by hundreds. 

Third. — By the absorption of poisons, as in the case of lead 
poisoning of painters. The other methods are so rare as to be of 
little importance. 

It is impossible to say just what is the smallest quantity of 
any poison that will produce death. That depends upon the age, 
weight and condition of the system, contents of the stomach 
and the peculiar constitution of the person. The administration 
of two grains of arsenic has proven fatal, while persons have 
taken as much as an ounce and recovered. In treating the 
various poisons the medicinal dose of each will be named. Any 
quantity larger than that is dangerous. 

SPECIAL POISONS. 

Mineral Acids. — Sulphuric acid, hydrochloric (or muriatic) 
acid, and nitric acid. 

These acids may be described as one, since they all pro- 
duce the same symptoms and require the same treatment. They 
are not g'iven as medicines until diluted so as to contain only 
about ten per cent of the pure acids, in which state they are 
known as dilute acids. 

The dose of dilute sulphuric acid is from five to ten drops. 

The dose of dilute nitric acid is from five to fifteen drops. 

The dose of dilute hydrochloric acid is from five to twenty 
drops. 

Symptoms of Mineral Acid Poisoning. — Severe burning pain 
in the mouth, throat and stomach immediately after swallowing 
the acid. The pain afterward extends over the abdomen and 
chest, and becomes excruciating agony. Stains will very soon be 
observed about the mouth and throat — sulphuric acid pro- 
ducing a gray stain that gradually becomes brown ; nitric acid a 
bright yellow; and hydrochloric acid either a whitish stain or 
none at all. Vomiting occurs without relieving the pam. 
12 



178 EMERGENCIES. 

Breathing is difficult ; swallowing is difficult and painful ; collapse. 
Death may result in a few hours or in several days. Hydrochloric 
acid is liable to produce suffocation. About 78 per cent of the 
patients recover, but in these strictures of the stomach and 
esophagus often remain. 

Treatment. — For the purposes of treatment it is not necessary 
to distinguish between the three acids. The treatment should be- 
gin at once. Milk in large quantities is one of the best antidotes. 
Magnesia, chalk, soda, soapsuds, or lime-water from fresh lime 
may be given. If none of the remedies are at hand lime-water 
may be prepared from lime scraped from a plastered wall. Be- 
ing alkalies these substances neutralize the acids. Do not give 
an emetic. Small pieces of ice relieve thirst and pain. Opiates 
may be necessary when ice will not suffice. In collapse give 
stimulants, such as whisky or brandy, and apply heat by hot water 
bottles, hot sandbags, etc. 

ALKALIES. 

The most important alkalies are caustic soda and caustic 
potash. The latter is the principal constituent of the lye used for 
soap-making and scouring. Every community has its case of a 
child that has swallowed lye. Adults are rarely poisoned by it. 

Symptoms. — A soapy taste in the mouth, followed by violent 
burning pain; the parts are swollen and stained; at first white, 
then red or brown. Vomiting occurs ; at first thick and slimy, later 
dark or tinged with blood. The matter vomited contains shreds 
of tissue from the throat and stomach and is alkaline. Perforation 
of the stomach, with peritonitis, collapse, or suffocation may cause 
death within twenty-four hours, but most cases do not result in 
death at once. About twenty-five per cent of all cases recover. 
The majority die in from one month to two years, from lack of nu- 
trition, caused by stricture of the esophagus or stomach. Of late 
years these strictures are relieved by a skillful surgical operation. 
Treatment. — One of the best antidotes for the alkalies is 
vinegar. It should be diluted with water until it can be taken as 
drink. Citric acid, or lemon juice, diluted, will also neutralize 
them. After these, olive oil, milk or eggs are useful. They unite 
with the alkali to form a harmless soapy mixture. Do not give 
emetics. Treat pain and collapse as in acid poisoning. If the 
patient survives, there will probably be strictures of the esophagus 
that will require surgical treatment. 



EMERGENCIES. 179 

AMMONIA. 

Symptoms. — Same as those for the alkalies. 

For treatment give dilute vinegar or lemon juice. These are 
better if mixed with oil. The later results must be treated by a 
physician. 

ARSENIC. 

Acute Arsenical Poisoning. — Arsenic occurs in the following 
compounds : Arsenic trioxide, the ordinary white arsenic, and the 
so-called arsenious acid sold in the shops. The medicinal dose is 
from gV to tV of a grain. 

Fowler's solution of arsenic ; dose from two to eight drops. 

Rough on rats contains ninety-six per cent of pure arsenic. 

Nearly all fly papers and fly poisons. 

Paris green and London purple. 

Wall papers colored with arsenical colors. 

Candies colored with arsenical colors. 

Impure subnitrate of bismuth. 

The fact that arsenic is practically tasteless accounts for its 
frequent use in homicidal poisonings. 

Symptoms. — The first symptoms of arsenical poisoning do 
not usually appear until from thirty minutes to an hour after 
the poison has been swallowed, though they may come on in a 
few minutes, or after several hours. Rapid appearance of symp- 
toms indicates a large dose and a dangerous case. The average 
duration of a fatal case is twenty-nine hours. The symptoms of 
arsenical poisoning vary more in different cases than those of any 
other poison. Only the most common can be given here. 

There is first a feeling of faintness and nausea. Vomiting 
soon begins and increases in frequency and retching continues, 
even after the stomach has been entirely emptied. The first mat- 
ter vomited is food, then watery and mucous substances, tinted 
often with blood, and nearly always colored green with bile. 
Vomiting is followed by pain, beginning in the stomach, then 
spreading over the abdomen and going through the back. This 
pain is sometimes said to feel "like a red hot coal in the stomach." 
Throat dry and parched and constricted with great thirst. Drink- 
ing increases pain and nausea. Later purging comes on with 
griping and straining. The stools are at first dark colored and 
fetid, but later resemble the rice water discharges of cholera. 



180 EMERGENCIES. 

Great prostration and collapse follow. The skin becomes cold 
and clammy. There are fainting spells and convulsions. Death, 
which occurs in about twenty-four hours, is quiet, the mind being- 
clear to the last. 

In some cases after twenty-four to forty-eight hours the pa- 
tient appears to be relieved and a recovery is looked for, but 
instead he gradually sinks and dies in from three to ten days. 
In other cases the patient soon becomes unconscious and remains 
so until death, which, in these cases, usually takes place in from 
four to eight hours. 

hi this connection it is necessary to say that one may become 
accustomed to taking arsenic, by gradually increasing the dose, 
until a large amount may be taken with safety. There are people 
who habitually eat arsenic, either to improve the complexion and 
personal appearance, or in mountainous regions to improve "the 
wind" for climbing the mountains. Such a person has been 
known to eat three or four grains a day, for nearly a lifetime, 
without bad results. 

Treatment. — First — Empty the stomach either by a stomach 
tube or such emetics as zinc sulphate or ipecac, but never give tar- 
tar emetic. Second — Convert what is left into a harmless com- 
pound. This is best done by ferric hydroxide, which is found at the 
drug stores. A physician should be summoned at once. Mean- 
time the giving of milk, melted butter, or lard, and stimulants 
will be of service. Arsenical poisoning cannot be well treated by 
other than a skillful physician. ' 

Chronic Arsenical Poisoning. — These cases occur from tak- 
ing arsenic too long in medicinal form, sometimes from a single 
large dose, in those working with arsenical compounds, and those 
living in rooms papered with arsenical paper. There are also 
cases where repeated small doses are given for a homicidal pur- 
pose. 

Symptoms. —Indigestion with vomiting, but little pain; 
headache ; fever resembling typhoid ; red patches on the skin ; 
redness and puffy appearance of the eyelids; cold in the head; sore 
throat ; scaling of the skin and falling out of the hair ; numbness 
in the hands and feet. Later there is weakness of the feet and 
legs, and finally complete paralysis. Death occurs from heart 
failure. 

Treatment. — Stop the arsenic and give iodide of potash in 



EMERGENCIES. 181 

closes of ten to twenty grains, three times a clay. There may be 
various injuries which will make necessary the presence of a phy- 
sician. 

LEAD POISONING. 

Acute. — Most cases of lead poisoning are accidental, and are 
chronic rather than acute. Lead is found in : 

Lead acetate, or sugar of lead, used medicinally, lead sub- 
acetate, or lead water, and in lead carbonate, or white lead, used in 
painting. 

Symptoms. — Sweet metallic taste ; other symptoms follow in a 
few minutes, but may be delayed an hour or more if the stomach 
be full. Vomiting begins early, is continuous and is increased 
by drinking, which is resorted to for the exceeding thirst. There 
is a colicky, abdominal pain that is characteristic of lead poison- 
ing. The tongue becomes coated and the breath has a sweetish, 
fetid odor. Headache, sleeplessness and cramps follow and the 
strength gradually diminishes. 

Treatment. — I. Empty the stomach either by a stomach tube 
or an emetic. 

2. Give Epsom salts in large quantities, and opiates for pain. 
Iodide of potash will aid in eliminating the poison from the sys- 
tem ; it may be given in doses of from ten to twenty grains three 
times a day. 

The patient should be kept upon a fluid diet. 

Chronic. — Chronic lead poisoning occurs in persons hand- 
ling lead, as painters, smelters and workers in chemical establish- 
ments. 

Symptoms. — Abdominal pains of a colicky nature commonly 
known as "painter's colic;" a bluish line on the gums at the mar- 
gin of the teeth ; constipation ; headaches, paralysis — especially of 
the extensor muscles of the wrist and fingers (wrist drop), so that 
the patient is unable to lift the hand or straighten the fingers. In 
some cases the arm cannot be raised. 

Treatment. — Remove the source of poisoning and give iodide 
of potash in doses of ten to twenty grains three times a day, to 
eliminate the poison. Morphine may be necessary to relieve 
the colic, in which case it may be given in doses of one-tenth to 
one-half grain once an hour. 



182 EMERGENCIES. 

MERCURY. 

Forms. — Metallic mercury, not poisonous. 

Mercuric chloride — calomel, rarely poisonous if pure. Dose, 
up to ten grains. 

Mercurous chloride — bichloride of mercury or corrosive sub- 
limate, frequently used as a disinfectant and bug exterminator, 
very poisonous. Medicinal dose, up to one-tenth of a grain. 

Red oxide of mercury — red precipitate ; used in ointments. 

Sulphide of mercury — vermilion ; used as a color. 

Symptoms. — On swallowing a mercurial poison there is an 
acrid metallic taste in the mouth that cannot be concealed, and 
in a very few minutes a sensation of hefat in the throat and 
stomach. In from three to ten minutes violent vomiting begins, 
and continues for several hours. The vomited material has a 
gray, mucus-like appearance, with shreds of tissue. Soon there 
is purging of copious, liquid, bloody, fetid passages, with pain 
and straining. The usual duration of a fatal case is from five to 
twelve days. 

On the second or third day there is salivation, with sore 
mouth, loose teeth and ulceration of the gums. The pulse be- 
comes small and fast, and the temperature is below normal, some- 
times going as low as 93 degrees Fahrenheit. Later there are 
paralyses, convulsions, and collapse preceding death. In cases that 
recover there is inflammation of the stomach and bowels that may 
last for several weeks. 

Treatment. — 1. Give albumen, such as white of tgg, and 
milk in large quantities, to unite with the mercury and for a time 
render it harmless. 

2. Then give emetics. 3. Next give stimulants, as whisky 
or brandy. 4. Iodide of potash will help get the mercury out 
of the system, and ten drop doses of tincture of belladonna, three 
times a day, will help the salivation. 

PHOSPHORUS. 

Cases of phosphoric poisoning are quite rare because of the 
decided odor and taste of the drug, and its luminous appearance 
in the dark. Phosphorus is found in some rat and vermin 
poisons, and on the tips of matches, and from these sources there 
are occasional cases of poisoning. Cases are on record in which 
fatal poisoning resulted from anointing the hands and face with 



EMERGEXCIES. 183 

phosphoric paste, for the purposes of "dark seances." Medicinal 
poisoning with phosphorus is extremely rare. The dose is one- 
thirtieth of a grain, or less. 

Symptoms. — First Stage. — After an interval of from two to 
six hours pain in the stomach, of a burning character, comes on, 
and there is headache, great thirst and low temperature. Belching 
occurs, and the odor of phosphorus is easily detected in the 
breath. Xausea and vomiting follow with plain evidence of phos- 
phorus. Later there is purging. After two or three days there 
is an apparent recovery, and the patient seems better for per- 
haps a week, then comes the second stage in which the former 
symptoms reappear, with pain in the region of the liver, with 
marked jaundice ; headache, fever and unconsciousness follow, and 
death results from exhaustion. 

Treatment. — Owing to the late appearance of symptoms 
there is more time for treatment. Wash out the stomach by means 
of a tube, or give of sulphate of copper fifteen grains. Physics 
should be given later. No oils or fats should be given until re- 
covery is complete. 



CHAPTER II. 
ACONITE. 

(Monkshead, Wolfsbane, Blue Rocket). 

Aconite is a vegetable preparation used in medicine, especially 
by eclectics and homeopathists. Dose of the tincture, rive to fif- 
teen drops. 

Symptoms. — Aconite acts rapidy if taken in a poisonous dose, 
the average duration of fatal cases being less than five hours. 
In a very few minutes there is a prickling sensation and feeling 
of numbness about the mouth that soon spreads over the entire 
surface of the body, and is especially noticeable in the hands and 
feet. The throat is dry and seems swollen, and there is a horrible 
choking sensation, which is spasmodic like hydrophobia, when the 
patient tries to swallow ; salivation ; vomiting, violent and contin- 
uous and of an explosive character ; the pulse becomes slow, irreg- 
ular and flickering; breathing is shallow and difficult. The pa- 
tient is pale, prostrated and fearful ; with blue lips, clammy skin 
and a low temperature. The eyes stare and the pupils are dilated. 
The patient may or may not be conscious. Death occurs in a 
fainting spell. 

Treatment. — An emetic of zinc sulphate should be given ; or 
preferably the stomach should be washed out with a solution of 
iodine in iodide of potash by a stomach tube. 

The breathing should be kept up by applying to the nostrils 
camphor or ammonia, or by artificial respiration. Heart stimu- 
lants, as strychnia, digitalis or atropia, are necessary. Nitrite of 
amyl is also useful. The extremities should be kept warm by hot 
bottles, rubbing, etc. 

THE BELLADONNA GROUP. 

There are several vegetable poisons that are very closely 
allied, and may be spoken of together. They are : 

Belladonna, or deadly nightshade, dose of the tincture, five 
to thirty drops. 

Atropine — a preparation from belladonna. 

184- 



EMERGENCIES. 185 

Stramonium — thorn apple, or jimson weed, a common weed 
in the central and western states. 

Hyoscyamus, or henbane. 

Poisoning occurs from taking the drugs by mistake, or in chil- 
dren from eating the berries of the weeds of this group. The 
deadly nightshade bears berries resembling those of a similar plant, 
known to country children as ground cherries, and eaten by them. 

Symptoms. — Dizziness; dryness of mouth and throat; no 
saliva; thirst; redness of skin, with heat, itching and dryness; eyes 
staring with pupils widely dilated; noisy delirium. The patient 
has hallucinations of all kinds and has to be restrained. He talks 
constantly in a nonsensical way. 

The delirium gradually subsides and the patient, if he does 
not recover, passes into a stupor, with slow snoring breathing and 
very weak pulse, from which he never awakes. 

Treatment. — Wash out the stomach or give an emetic. Mor- 
phine given hypodermically is a physiological antidote. 

Tendency to sleep should be combated, as in opium poisoning, 
by walking and slapping, also by brandy, nitrite of amyl and arti- 
ficial respiration. 

HYDROCYANIC ACID. 

(Prussic Acid). 

This substance is found in bitter almonds, the kernels of the 
peach, cherry, plum and other fruit tree seeds, in the bark and 
leaves of many plants, in the cyanide of potash used in photog- 
raphy, and in Prussian blue and other chemicals. The medicinal 
preparation contains but two per cent of the pure acid and the 
dose is from two to eight drops. Cases of poisoning in children, 
from eating quantities of peach or other kernels, are not rare. 

Hydrocyanic acid is the most deadly of all ordinary poisons. 
Of 455 reported cases, eighty-four per cent resulted fatally, and 
the average time from taking the poison until death was only 
half an hour. In a large number of the cases death occurred in less 
than five minutes. Whatever is done for hydrocyanic poisoning 
must, indeed, be done quickly. In most cases the physician ar- 
rives too late to be of any service. 

Symptoms. — If a large close be taken, consciousness is lost 
almost at once and the patient falls to the ground. There are 
slight convulsive movements, then he lies still in a state of col- 



186 EMERGENCIES. 

lapse, breathing only at intervals, and in a few minutes the breath 
stops entirely. For such cases treatment is generally useless. 

If the dose was smaller there are a hot, bitter taste and a 
choking sensation. Then come severe headache, dizziness, mental 
confusion, insensibility and loss of all muscular power. The face 
is pale, though full ; the eyes staring, glassy and rolled upward. 
There is frothing at the mouth and convulsions, resembling those 
of lockjaw. The patient does not vomit. 

Treatment. — If peach or other kernels have been swallowed, 
give an emetic, as zinc sulphate. 

Artificial respiration should always be practiced, as in cases 
of drowning, and the breathing may be stimulated by holding to 
the nostrils camphor or ammonia. Such stimulants as whisky, or 
other spirits, and strychnia are very useful. If the acid has been 
taken by the mouth the stomach should be washed out with a 
solution, either of permanganate of potash or peroxide of hydro- 
gen. 

The electric current is a good stimulant for the heart. If 
the patient can be tided over the first half hour he is probably safe. 

CONIUM. 
(Poison or Spotted Hemlock). 

Although this plant grows abundantly in some parts of 
America, poisoning from it in this country comes principally from 
the medicinal preparations, and is somewhat rare. 

Symptoms. — Loss of muscular power, beginning in the legs ; 
staggering gait; drooping eyelids; dilated pupils; some nausea 
but no vomiting; speech becomes difficult and is finally lost; swal- 
lowing is difficult ; the mind remains clear to the last. Death re- 
sults from paralysis of the muscles of respiration. 

Treatment. — Remove the poison from the stomach by zinc 
sulphate, mustard, or any other emetic, and stimulate by hot ap- 
plications to the spine, and by the use of spirits, and perform 
artificial respiration, as in cases of drowning. 

OPIUM AND OPIATES. 

Opium is obtained from the juice of the poppy. It is found 
in the following preparations : 

Extract of opium. Dose — From one-half to two grains. 

Dover's powder contains ten per cent of opium. Dose — Five 
to fifteen grains. 



EMERGENCIES. 187 

Tincture of opium, or laudanum. Dose. — Five to thirty 
drops. 

Camphorated tincture of opium, or paregoric. Dose — Five 
to sixty drops. 

Morphine. Dose — One-tenth to one-half grain. 

Codeine. Dose — One-sixth to one grain. 

A large number of proprietary nostrums, such as soothing 
syrups, pectoral syrups, cough syrups, bronchial troches, etc., 
contain morphine as their principal ingredient. From thirty-five to 
forty per cent of all cases of poisoning are by opiates. Infants 
and young children are especially susceptible to their poisonous 
qualities. The action of morphine is more diminished by habit 
than that of any other poison. De Quincey relates that at one time 
he took nine ounces of laudanum daily. Another "fiend" took 
1 20 grains of morphine at a single dose without ill effects. 

Symptoms of Opium Poisoning. — After an interval of from 
thirty minutes to an hour the patient becomes excited and restless, 
talks fluently and pleasantly, and moves about much. This is 
known as the stage of excitement and lasts but a few minutes. 
It is absent in habitues. Then comes a period of drowsiness and 
diminished sensibilities. There is a sensation of weight in the ex- 
tremities, and the desire to sleep is irresistible. At first the sleep 
is normal and the patient may be aroused. The skin is pale and 
the pupils contracted. The patient passes into a deep, heavy sleep 
(coma) from which he cannot be awakened. He lies perfectly 
motionless with eyes closed, their pupils the size of a pinhead; the 
skin pale and moist ; lower jaw drooping, and the muscles com- 
pletely relaxed. The respiration is slow, shallow and snoring. The 
tongue falls back in the throat and mucus accumulates there, 
causing the rales popularly known as the "death rattle." The 
body cools rapidly and, if treatment is not successful, death takes 
place in from twelve to twenty-four hours. If, after the deep sleep, 
the treatment is so far successful that the patient can be aroused 
recovery will probably be made, although he may remain asleep 
from twenty-four to thirty-six hours longer. 

Treatment. — First remove the poison from the stomach by 
the use of emetics. If possible arouse the patient by slapping 
with wet towels, or by an electric current, then keep him awake 
by walking him between two persons. Strong coffee, or caffeine 
in one grain doses, is useful. Strychnia (one-fortieth of a grain) is 



188 EMERGENCIES. 

a good heart tonic, and if breathing fails artificial respiration 
should be kept up, for hours if necessary. As the patient does 
not pass urine, the bladder should be watched and the urine drawn 
with a catheter. 

COPPER. 

Found in : 

Cupric sulphate or blue vitriol or blue stone ; medicinal dose, 
as an emetic, ten to fifteen grains. 

Verdigris, a mixture of copper acetates; sometimes found on 
copper or brass vessels, containing acid substances. 

Cases of poisoning from copper are rare. While it is possible 
that poisoning may occur from eating food that has stood in 
copper vessels, most such cases are really poisoning from bacteria, 
ptomains, or trichinae. 

Symptoms. — Pain in the stomach, extending over the abdo- 
men, accompanied by vomiting of greenish matter. There is 
also purging, with frequent scanty urination. The urine is al- 
most black. There are cramps in the legs, weakness and head- 
ache. There may be a decided improvement followed by relapse. 
The average duration of fatal cases is fifty hours. 

Little can be done except by a physician. If the stomach has 
not already been emptied, emetics should be given; then give milk 
or eggs. Soap and soda are chemical antidotes. Stimulants, such 
as whisky or brandy, may be necessary. 

COCAINE. 

Symptoms. — Restlessness and excitement, dizziness, head- 
ache, delirium, difficult breathing, rapid feeble pulse and dilated 
pupils. Most cases end in recovery. 

Treatment. — Strong coffee, or caffeine in one grain doses 
every hour, nitrite of amyl by inhalation, and stimulation by 
whisky, brandy, etc. 

NICOTINE. 

Nicotine is an alkaloid of tobacco. Its action may be as rapid 
as that of hydrocyanic acid. Death has occurred from it in less 
than five minutes. 

Symptoms. — Faintness, nausea and vomiting, headache, dim- 
ness of vision, deafness, drowsiness and fainting spells. The pulse 
is rapid and weak, the breathing quick and the skin cold. 



EMERGENCIES. 189 

Treatment. — Place the patient in bed and empty the stomach 
by a tube or emetic; then give tannin in twenty grain doses every 
two hours; or strychnia in one-fortieth of a grain doses once in 
two hours; or stimulants, as whisky or brandy, and apply heat to 
the hands and feet. 

STRYCHNIA AND NUX VOMICA. 

Strychnia is the active principle of mix vomica. Dose. — 
From one one-hundredth to one-fortieth of a grain. 

Tincture of nux vomica. Dose. — From five to twenty drops. 

Cases of strychnia poisoning are common, both accidental 
and intentional. Strychnia has been mistaken for quinine, cal- 
omel, etc., and children have been poisoned by eating animal 
poisons containing strychnia. The least amount of strychnia that 
will cause death is one-half grain, in a healthy adult. In fatal 
cases death usually occurs within one hour, is rarely delayed be- 
yond two hours, and may occur within a few minutes. If the pa- 
tient survives two hours, recovery is probable. 

Symptoms. — A bitter, hot taste is noticed on sw T allowing the 
poison. In a short time, usually ten to twenty minutes, spasms 
begin. At first there are twitchings of the muscles, followed by 
violent convulsions, resembling those of lockjaw. During the 
spasm every muscle is contracted and the head is drawn back- 
ward, the jaws are locked, and the eyes protrude with dilated pupils. 
There is frothing at the mouth, swelling of the neck and a hideous 
distortion of the features. This spasm passes off, but is followed 
by others at shortening intervals. The spasm lasts from thirty 
seconds to ten minutes, and there may be from one to ten of 
them. In fatal cases death usually occurs in the fourth or fifth 
spasm. The whole course closely resembles that of lockjaw. 

Treatment. — Owing to the short time available for aid, a phy- 
sician should be summoned at once, if within call. Meantime 
the stomach should be emptied by emetics or other means ; then 
chloral in fifteen grain doses every fifteen minutes, or chloroform 
by inhalation, are the best remedies. 

Tannin in twenty grain doses every hour will do some good, 
or whisky may be given to the point of intoxication. Opium or 
morphine should be given only when no other antidotes can be 
obtained. The patient should be kept perfectly quiet, in a dark 
room, undisturbed by noise or sudden movements of attendants. 
Artificial respiration may be necessary. (See page 196.) 



190 EMERGENCIES. 

DIGITALIS. 

(Foxglove.) 

Dose of the tincture, from one to five drops. 

Symptoms. — Vomiting" and purging of green material, fol- 
lowed by headache, delirium and convulsions. The skin is cold 
and clammy and the pupils of the eyes are dilated. Death occurs 
suddenly from heart failure. 

Treatment. — Keep the patient lying down, empty the stom- 
ach by emetics and give tannic acid every hour in twenty grain 
doses. Stimulate by heat applied to the hands, feet and limbs and 
over the heart, and by strong, hot coffee or whisky, 

CHLORAL, OR CHLORAL HYDRATE. 

Dose, from five to thirty grains. 

Symptoms. — Immediate burning pain in the mouth, throat 
and stomach. After a short period of excitement the patient 
sinks into a deep sleep, which in fatal cases may last seventy-two 
hours. In fatal cases the sleep deepens into coma, with snoring 
breathing, muscular relaxation, cold skin and failing pulse and 
respiration. 

Treatment. — Empty the stomach by tube or emetics and ap- 
ply heat to the body. Try to rouse the patient and stimulate with 
ammonia by inhalation, electricity, or strychnia in one-fortieth 
grain doses every two hours. 

CARBOLIC ACID, OR PHENOL. 

Symptoms. — The symptoms appear quickly. There is burn- 
ing of the mouth and throat, producing a white stain that after- 
ward turns red. Vomiting, with the odor of carbolic acid, may 
occur. The odor of the acid can always be detected in the breath. 
The patient soon becomes unconscious and sinks into a state of 
collapse, with snoring breathing, purple face, contracted pupils 
and cold skin. In fatal cases death usually occurs in from two to 
eight hours. 

Treatment. — Emetics should first be given, then Epsom salts 
in large quantities (from one-half ounce to one ounce hourly). Oil 
will counteract the corrosive effect. If there is none at hand, 
melted butter or lard may be used. Treat the collapsed condition 
by stimulants and the application of heat to the spine. Atropine 
in one one-hundredth of a grain doses is an antidote. 



EMERGENCIES. 191 

ZINC. 

The chloride of zinc is the most common form. 

Symptoms. — Burning in the throat and stomach, with vomit- 
ing and purging, followed by compulsions and coma. 

As treatment give soda, milk, eggs, or tannic acid in twenty 
grain doses every two hours. 

IODINE. 

Most cases of iodine poisoning come from taking the tincture 
through mistake. 

Symptoms. — Burning pain in the throat and stomach, with 
vomiting and purging. 

Treatment. — Give an emetic, then follow it with starch in any 
form. It may be necessary to give opiates to relieve pain. 

POISON IVY. 

(Poison Oak.) 

This is an exceedingly poisonous vine, climbing by rootlets 
over rocks, fences, trees, etc., having compound palmate leaves, 
each consisting of three leaflets, and bearing clusters of small, dark 
berries. Some persons can handle it without being injured, while 
others are poisoned by coming into its vicinity without even 
touching it. 

Symptoms. — Swelling and redness of the skin, accompanied 
by intense itching and burning, and in many cases by the forma- 
tion of small watery blisters. 

Treatment. — If the parts affected by the plant be immediately 
washed with ordinary alcohol there will be no further symptoms. 
If this has not been done in time, and swelling and eruption or 
blisters have appeared, the parts should be washed in a solution 
of subacetate of lead, as often as may be necessary to give relief. 
If the pain is great use the following : 

Solution of subacetate of lead, two parts. 

Tincture of opium, one part. 

Water, one part. 

One teaspoonful of the fluid extract of grindelia robusta in 
four tablespoonfuls of water applied to the parts is an excellent 
remedy. 

The poison is an acid and the object of the treatment is to 
neutralize it bv alkaline washes. 



192 EMERGENCIES. 

If the above remedies are not accessible, apply strong solu- 
tion of common baking soda, ammonia water, lime water, weak 
lye, or soft soap. 

POISON SUMAC. 

This is a shrub from six to eighteen feet high, grows in 
swamps and, in the Northern States, flowers in June. Its bark 
is smooth and its leaves compound, with from seven to thirteen 
leaflets. It is often called, incorrectly, Poison Elder and Poison 
Dogwood. 

The symptoms and treatment are the same as in poisoning 
from ivy. 

MUSHROOMS. 

The poisonous varieties of the mushrooms are usually colored 
red and yellow, but no certain rules for detecting them can be 
given. Varieties harmless to some may be poisonous to others, 
though not fatally so. Tyson says : "Avoid highly colored fungi 
with astringent taste and pungent odor." 

Symptoms of Mushroom Poisoning. — Excitement with vio- 
lent colicky pains, vomiting and diarrhea. The skin is cold and 
the pulse slow, showing a failing heart. 

Treatment. — Give emetics and after their action give physics. 
Stimulate by applying heat externally and by giving spirits in- 
ternally, as whisky or brandy. 

Atropine is the physiological antidote, but it should only be 
given by a physician. 

PTOMAINS. 

Ptom'ains are poisons resulting from the decay of animal or 
vegetable matter. Recent studies show that they are formed by 
microbes, otherwise known as bacteria, bacilli, etc. The prin- 
cipal ptomain poisons are those of meat, milk and fish. 

i. Meat poisoning follows the eating of meat that has under- 
gone decomposition, and may result from ham, beef, mutton, sau- 
sage, poultry or canned meats. 

2. Milk and its products. There is a ptomain peculiar to 
milk, cream, cheese, and various other eatables, composed prin- 
cipally of milk. It is called tyrotoxicon. 

3. Fish that have decomposed contain ptomains. 

4. Mussels frequently contain ptomains. Whether they 
are peculiar to a certain variety of mussels, or are common to all 



EMERGENCIES. 193 

varieties, is uncertain, but it is known that mussels found in stag- 
nant water are most frequently poisonous. Mussels may be poi- 
sonous to some persons and not to others. 

The symptoms in all kinds of ptomain poisoning do not 
greatly vary — being the symptoms of violent inflammation of the 
stomach and intestines. 

In fatal cases death does not generally take place in less than 
forty-eight hours. 

Symptoms. — Nausea, vomiting, cramps and diarrhea or con- 
stipation. 

There is dryness of the throat, disturbance of vision and great 
prostration. 

Treatment. — Ptomain poisoning is more like a disease than 
most other forms of poisonings, and cannot be well treated except 
by a physician. Uusually there is. sufficient vomiting and purging 
to expel from the body the poison not absorbed. If not, emetics 
should be given and followed later with physics. Stimulants are 
necessary, such as heat and spirits, or strychnia in one-fortieth 
grain doses once in two hours. Opiates may be given to allay 
the pain. 

TURPENTINE. 

Although not a real poison, turpentine may cause serious 
harm, and even death, if taken in sufficient quantities. It has been 
used for producing abortions, for which it is an insufficient and 
very dangerous agent, and it is frequently taken for coughs and 
colds. The medicinal dose is from five to thirty drops, and more 
than that should never be taken. 

OBJECTS SWALLOWED. 

Stones, coins, buttons and various other small objects are 
frequently swallowed by children, to the great alarm of their 
parents. These accidents seldom do any harm. A full meal of 
mashed potatoes is an excellent antidote. The object will be en- 
closed in a ball of the soft potato and do no harm until expelled 
from the body. 

Sometimes by quickly grasping the child by the heels, hold- 
ing him head downward and rapping him briskly on the back with 
the palm of the hand, the object will fly out of his mouth. 



rs 



CHAPTER III. 

DROWNING. 

Respiration is absolutely necessary to life. When God 
breathed into man the breath of life, man became a living soul, 
and when the breathing stops his body soon becomes a clod. 
Death from lack of air, or oxygen, which is the essential element, 
is scientifically known as asphyxia. In drowning, asphyxia is 
caused by water entering the lungs, or otherwise cutting off the 
entrance of air. 

The time that persons may remain under water without losing 
their lives varies greatly. The latest and best authorities state 
that, in the great majority of cases, death takes place within two 
minutes, and that after five minutes recovery is very doubtful, 
but there appear to be well authenticated cases in which persons 
were restored after having been under water for half an hour. A 
person in a fainting or cataleptic state will survive much longer 
than one who continues to fight until suffocation takes piace, since 
the latter, in his struggles for breath, draws water into the lungs, 
while the former stops breathing immediately, and, by closure of 
the glottis, water is prevented from entering the lungs. 

Efforts should always be made to revive a person, even though 
he has been under water an hour or two, unless it is plain that the 
heart has stopped. As long as there is the slightest flutter in the 
region of the heart, all efforts should be made persistently and 
continued for hours, if need be ; but when it is certain that the heart 
has stopped, further attempts are useless. Other functions of the 
body may cease and begin again, but when the heart stops it stops 
forever. 

Three things should be considered in treating a case of 
drowning : 

i. Get the water out of the lungs, that the breathing may be 
restored. To do this, piace the patient on his face with his head 
and shoulders lower than his hips. A roll of clothing or blankets, 
a log, barrel, or any similar device, may be placed under the abdo- 
men, and the mouth should be kept open by tying a handkerchief 

194 



EMERGENCIES. 



195 




196 EMERGENCIES. 

through it like a gag, then press firmly upon the spine below and 
between the shoulders. The water will run out and very soon 
empty the lungs. Should none of these things be at hand, lose no 
time in looking for them, but immediately step astride the body 
as it lies face downward, and, clasping your hands below the abdo- 
men, lift the middle of the body as high as possible and hold it 
there, the face still resting on the ground, until the water has 
run out of the lungs. Many prefer this to the first method. 

2. Restore the breathing' by artificial respiration. There 
are many ways of doing this, of which the following, known as 
"the Satterthwaite Method," is perhaps the best : As soon as 
the water has been gotten out the lungs, turn the patient on his 
back, keep his mouth open (by a gag, if necessary), and draw out 
the tongue, press gently, but firmly and slowly upon the abdomen, 
then suddenly remove the pressure. The direction of the pressure 
should be backward (toward the spine) and upward (toward the 
lungs). Repeat these movements five or six times a minute, and, 
later, ten or fifteen times a minute, but do not become excited 
and make them more rapid than that, and do not pound or slap 
the patient. 

The Sylvester Method is probably more widely known than 
any other, and is as follows : With the patient lying on his back 
place a roll of clothing under his shoulders to raise them three to 
five inches, the back of the head still resting on the ground, and, 
kneeling back of his head and grasping his forearms just below 
the elbows, press them very firmly, but gently upon his abdomen, 
as shown in Fig. i, then slowly raise them to the position shown 
in Fig. 2, keeping the elbows well apart and higher than the shoul- 
ders, and continue the movement until the arms are brought above 
the head as shown in Fig. 3. Hold them there five seconds, then 
return to the first position and press again upon the abdomen so 
firmly as to drive the air out of the lungs. Repeat this series of 
movements five or six times per minute, later increase them to fif- 
teen times per minute and thus continue until the natural breath- 
ing is restored, or all possible chance of recovery has passed. 
When there are assistants, the two methods may be carried on 
simultaneously, one person pressing the abdomen at the same time 
that the other operator presses down upon it with '-.he arms, and 
removing the pressure when the arms are raised. 

Other assistants should meantime remove the wet cloth- 



EMERGENCIES. 197 

ing, ripping or cutting it off, if necessary, to get it away quickly, 
especially remove all constriction from the waist and chest, and 
wrap the patient in warm, dry clothing, overcoats, blankets, or 
any such thing obtainable ; then rub the body under the cloth- 
ing, particularly upon the extremities, making the frictional move- 
ments toward the heart to restore the circulation. Apply am- 
monia to the nostrils, and heat, as hot stones, bricks, cloths, or 
hot water bottles, if it is possible to get them, to the extremities. 
Artificial respiration should be continued for hours, if there is the 
slightest hope of success. In drowning, and in many cases of 
poisoning, it is of more value than electricity, or any other known 
restorative measure. 

3. Stimulants. — When the pulse returns to the wrist, warm 
drinks, beef tea, or alcoholics, if very carefully administered, may 
be given. 

SUFFOCATION. 

Suffocation from smoke, poisonous gases, loads of earth, 
hanging, or any other cause, should be treated by artificial respira- 
tion, and in every other way, as outlined for drowning, except 
that in these cases dashing cold water in the face often aids in 
restoring to consciousness. 

FROST BITES. 

The principal object in treating frost bites is to bring about 
a gradual restoration of sensation, circulation and heat to the in- 
jured part. If the temperature be raised suddenly great pain will, 
and permanent injur}' ma}", follow; while if the temperature be 
raised very slowly, complete recovery will often take place, al- 
though the extremity or part of a limb is completely frozen. When 
restoration does not occur gangrene follows, which, in case of a 
limb, necessitates amputation. Freezing is accompanied by a 
sense of numbness, and is shown by the white, blanched appear- 
ance of the part. 

Treatment. — First rub with snow, or put the part in ice water, 
and use gentle friction, the patient always being kept in a cold 
room, and never placed in a warm bed. Gradually raise the room 
temperature, also that of the water bath. After the natural tem- 
perature of the body returns, warm drinks and stimulants may be 
given. Cases of gangrene must be treated by the surgeon. In 



198 EMERGENCIES. 

case of apparent death from cold, the treatment should be used, to- 
gether with artificial respiration and heart stimulants, such as 
strong coffee, whisky or brandy, or strychnia — one-fortieth of a 
grain every two hours. There are cases on record in which re- 
covery occurred after unconsciousness and burial in the snow for 
several days. 

SUNSTROKE, OR HEATSTROKE. 

Sunstroke is a very high fever, resulting from exposure to the 
heat of the sun. The same condition may result from exposure to 
a high temperature artificially produced, as in laundries, the fire- 
rooms of steamships, etc. Sunstroke is rare in a dry atmosphere, 
but frequent in a moist one, even at twenty degrees lower tempera- 
ture. Persons who drink alcoholic liquors to excess are more 
liable to this danger than the temperate. After recovery from a 
"sunstroke" mental injury may remain, and very frequently those 
who have once suffered from it cannot afterward endure even a 
moderate degree of heat without headache and nervous excite- 
ment. Sunstroke may be followed by meningitis or, more rarely, 
by epilepsy. 

Symptoms. — There is first a sense of burning, heat and op- 
pression, which may be accompanied by dizziness, headache, 
vomiting and sometimes diarrhea. Unconsciousness then comes, 
with restlessness and delirium. 

The face is flushed, the eyes bloodshot, the skin hot and dry, 
the breathing labored and the temperature very high (107 degrees 
to 112 degrees Fahrenheit). There may be slight convulsive 
movements; the unconsciousness becomes a stupor- and the stupor 
a coma. The pulse grows rapid and the breathing irregular. 

If consciousness returns and the -temperature begins to fall, 
recovery may be expected. A temperature above 110 degrees 
indicates that recovery is improbable. Death occurs after several 
hours. 

Treatment. — There is but one immediate object in the treat- 
ment — to lower the temperature ; and that as speedily as possible. 
This is best done by stripping the patient and placing him in a cold 
bath ; the colder the better. If ice can be had it should be added 
to the water, and the skin rubbed with pieces of ice. Ice water 
injections into the rectum are also useful. If bathing facilities are 
not at hand the patient should be stripped and placed on a piece 



EMERGENCIES. 199 

of oil cloth and cold water be poured over him. A horse trough 
and pump will answer the same purpose. Do not fear his taking- 
cold, but use every means at hand. Of course, the temperature 
should be watched and when it begins to go down the heroic treat- 
ment should be gradually lessened until the body reaches some- 
thing like its natural temperature (98.6 degrees). 

BURNS AND SCALDS. 

Burns and scalds do not differ in their effects. In fact, a scald 
is only a burn made by a fluid substance. A burn may be pro- 
duced by a variety of substances; such as heated metals, hot water 
or steam, lightning or electricity, acids, alkalies, molten metal, 
etc. Practically, the symptoms and treatment are the same, but 
there is a difference in the degree of severity of burns that is 
highly important. Physicians very logically divide burns into 
three classes, according to the degree of injury. 

Bums of the First Degree. — A burn of the first degree pro- 
duces only a redness of the skin, with slight inflammation and 
some pain. It leaves no after effects, and should be treated by 
the application of common dry baking soda and a wet cloth, or 
by smearing over with carbolized vaseline. 

Bums of the Second Degree. — A burn of the second degree 
is more severe and produces a blister. The blister should be punc- 
tured, then treated as above. Other applications are lard, olive oil 
and flour, any of which should be covered with a damp cloth. An 
old remedy is carron oil, composed of equal parts of olive oil and 
lime-water, but it is one of the poorest of all remedies. An ex- 
cellent application, and one that is always at hand, is ordinary bak- 
ing soda. It should be dusted on plentifully until the wound is 
well covered, then bind a wet cloth over all. The soda relieves 
pain, keeps the wound clean, and promotes healing. Opiates or 
chloral should be given if necessary. Bits of ice will relieve thirst. 

A saturated solution of picric acid is a comparatively new 
remedy for burns, and is probably the very best. Spread a thin 
layer of cotton, wet in the solution, over the burn. It gives in- 
stant relief, and should be renewed from time to time to keep the 
skin constantly wet. A burn upon a patient in good health will 
heal very rapidly under this treatment. The acid is poisonous, but 
is soluble in water to the extent of only one-half of one per cent, 
hence, unless spread upon very large surfaces, there is no danger 
from absorption. 



200 EMERGENCIES. 

It was formerly thought that a burn of the second degree, or 
even of the first, affecting one-third of the surface of the body, 
must prove fatal, but patients now are often saved, after having 
been burned very much worse, by simply keeping their wounds 
away from the air by constant immersion in water until the new 
skin forms. For this purpose a bath tub should be quickly pre- 
pared by making a triangular support of clean boards for the legs, 
also supports for the head and back, as shown in the illustration. 




Immersion for Severe Burn 



A soft blanket, folded in several thicknesses, is then spread over all, 
the patient placed thereon, and water, at' 94 degrees Fahrenheit, 
turned in until it rises to his neck, after which a small stream, warm 
enough to maintain the temperature as nearly as possible at 94 de- 
grees, must be kept running into the tub, and an overflow of the 
same size provided for. that by continual, gradual change the 
water shall be kept pure. A watchful attendant must remain con- 
stantly with the patient until the recovery is made. Patients have 
been kept thus under water for weeks, even months, and finally 
saved, although at first their cases seemed hopeless. Unless thus 
treated, if one third of the body surface is burned, death follows 
within forty-eight hours. It is fortunate that in very severe burns 
the patient is spared great suffering by dying during the uncon- 
scious period of shock. 

Burns of the Third Degree are still more severe, and are those 
by which some part of the body is burned to a black char and 
destroyed. They are often fatal, but if not, they always leave a 
disfiguring scar, and should be treated by a surgeon, if possible. 
They may be fatal in a variety of ways, as from immediate nervous 



201 

shock, congestion of the brain, erysipelas, or inflammation of any 
of the internal organs. 

The objects of the treatment should be twofold: 

i. To Relieve Pain. — The directions for doing this we have 
already given. An important factor in most applications for re- 
lieving pain is the exclusion of air from the burned surface, which 
should be covered with a silk or rubber protector, then with cot- 
ton and loose bandages. The dressings should be changed every 
three or four days. 

2. To Relieve Shock. — Treat the shock by rest and warmth 
and, after consciousness returns, give stimulants, such as hot cof- 
fee, milk punch or beef tea. 

A large burned surface that does not heal readily should not 
be allowed to heal by granulation, but should be covered by skin 
grafts to avoid the contraction of the scar which, without this pre- 
caution, will always .cause great deformity, and is liable to be so 
serious as to destroy the use of the limb. Poultices are not used 
by the modern surgeon. They are apt to cause suppuration, just 
what should be avoided. Everything in the dressing of wounds 
should be done with reference to preventing suppuration. 

Inhalation of hot air is one of the deadliest of all the dangers 
incident to fires, but one which by a little intelligence, calmness 
and seif-control can usually be overcome. If caught, so that the 
only escape lies through the fire, quickly tie a handkerchief, stock- 
ing or other article of clothing over the mouth and nose, or if 
there be no chance for this, having filled the lungs with air, clasp 
the nose and mouth in the hand, and, remembering, no matter 
how great the pain, that life depends upon holding the breath, 
dash through the flames to safety. As cotton ignites far more 
readily than wool, draw on woolen clothing if possible before ex- 
posure to the flames. 

LIGHTNING OR ELECTRIC SHOCK. 

The injuries produced by electricity are nervous shock, burn- 
ing and paralysis. These shocks should be treated the same as 
any other shock — by applications of heat to the spine, strong cof- 
fee and other stimulants. 

The burn should be treated just as any other burn. The 
paralysis should be treated by an intelligent physician; and when 
so treated usually disappears. 



202 EMERGENCIES. 

BITES AND STINGS OF INSECTS. 

Leptus (Harvest Mite). — This pest is a minute red mite, 
which buries itself in the skin. It attacks all parts, but more 
often the ankles, causing pimples which are very itchy or burn- 
ing. 

Treatment. — Bathe the part with a dilute wash of carbolic 
acid. 

Bees, Wasps and Hornets. — The bites and stings of many in- 
sects, as the mosquito, bee, wasp and hornet, may not only be 
severe and very painful, but death has sometimes occurred, either 
from the shock to the nervous system or from absorption of the 
virus. Children suffer more from them than do adults, because 
of the more impressible nervous system in youth. 

Treatment. — Soda and ammonia are common household rem- 
edies, but they afford little relief. Water containing all the sugar 
of lead it will dissolve is an excellent remedy and is best applied 
with absorbent cotton. Wet salt or mud may be used. Ichthyol 
is a newly discovered drug, which relieves the pain and swelling of 
a sting almost instantly. It should be spread on pure with a brush, 
in which case it will act surely and promptly. 

Spiders are also able to inflict severe injury by the injection 
of poison. In warm countries the tarantula is well known from 
the severity of its bite. Some species of ants and caterpillars also 
attack the human skin and produce burning, stinging pain, with 
more or less swelling. Treat all these bites with sugar of lead 
or ichthyol, as recommended for bee stings. It is a wise precau- 
tion to lance a tarantula bite and cause free bleeding as soon as 
possible. If no other remedies can be quickly obtained cover the 
part with mud, first sucking the wound vigorously and spitting- 
out the poison. One with sore lips, sore mouth or decayed teeth 
should never attempt this for another person, lest he absorb the 
poison into his own system. 

BITES OF SERPENTS. 

Many people firmly believe that the bite of any and every 
snake is poisonous and dangerous. This idea is erroneous. Ac- 
cording to the best authorities, there are only three poisonous 
snakes in North America ; and in a great many cases a bite by one 
of these does not prove fatal. The venomous snakes of this coun- 
try are: The Rattlesnake [crotalus Jwrridus), the Copperhead (tri- 



EMERGENCIES. 203 

gonocephalus), and the Moccasin. In Europe the only dangerous 
snake is the viper. In India and South America there are many 
others. 

The poison apparatus is similar in all. It consists of a sac 
containing the venom, situated below the eye and near the root 
of the fang; the fangs, two in number, in the upper jaw, and a tube 
leading from the sac through each fang to its point. Pressure on 
the fang produces pressure on its sac, forcing the venom out 
through the tube. This venom, or poison, seems to be almost 
indestructible. Nothing affects it; neither heat nor cold; acids 
nor alkalies ; time, nor decomposition. Yet it is perfectly harm- 
less when taken into the healthy stomach. It acts upon children 
more seriously than upon adults. 

Symptoms. — The part bitten immediately swells and becomes 
painful ; dark, red spots appear and the swelling spreads ; giddi- 
ness comes on with dizziness and dimness of vision ; clammy sweat 
and great terror. Later there may be nausea and vomiting; the 
pulse grows fast and feeble and the breathing labored. Death may 
occur quickly, but usually not until from five to forty-eight hours. 
If the case does not yield to antidotes, blood poisoning, which 
is always a serious affair, comes on. The part is then greatly 
swollen, and the skin becomes puffy and mottled; often giving 
rise to the idea that the person is turning to the color of the 
snake. This condition demands the services of a competent phy- 
sician at once. 

Treatment. — The wound should be sucked or cupped, but 
always bear in mind that the person who sucks any poisonous 
wound must have a perfectly healthy mouth and sound teeth. If it 
be an extremity that is bitten, a moderately tight bandage above 
the bite will to some extent prevent the spread of the poison ; but 
this bandage must not be left on too long. The principal anti- 
dote is a stimulant of some kind. Ammonia is very good, but as 
whisky is efficient, and usually at hand, it will probably continue to 
be used more than all other remedies. In its use, but one caution 
is necessary; do not give it to the point of intoxication. When 
so given it adds to the effects of the poison, instead of combating 
it. Give the whisky slowly until it produces a slight exhilaration, 
then stop. When this effect begins to pass off give a little more 
and thus continue and it will prove safe and effective. 



204 EMERGENCIES. 

HYDROPHOBIA. 

Hydrophobia, or rabies, is an infectious disease of animals, 
which is sometimes communicated to man. The dog is the most 
frequent subject of the disease, but it is sometimes also seen in 
the horse, mule, cow, wolf, skunk, rat, cat, pig and rabbit. Its 
cause is a virus, most probably a germ, contained in the saliva of 
the afflicted animal and from it communicated to others and to 
man. The time from the infection until the appearance of the dis- 
ease is usually about six weeks, but may be as short as one w T eek, 
or as long as several months. If the disease does not appear in 
less than eight months it will, in all probability, never appear. 

Not all of those bitten by rabid animals become infected. 
One eminent authority says only fifteen per cent, but the greater 
number say that about two-thirds of those bitten take the disease. 
Of course, there are many who think they have been bitten by 
mad dogs, when, in fact, the dogs were not rabid. Children are 
more susceptible than grown people, and bites in the face are much 
more dangerous than those upon other parts of the body. The 
next most serious location is the hand. When the disease has ap- 
peared, all treatment and all hope are vain. Dr. Nicholas Senn 
says : "In man this terrible disease is invariably fatal. There is 
not an authentic instance of recovery from genuine hydrophobia/' 

Symptoms of Hydrophobia in Dogs. — Hydrophobia means 
"fear of water," and in man a dread of water is the most prominent 
feature of the disease ; but dogs drink with eagerness and manifest 
no such fear. This is contrary to the general opinion, but, never- 
theless, true. At first the dog becomes dull and morose, mopes 
and avoids his master and companions; then restless, and runs 
about barking and snapping at imaginary objects. During this 
time there is rarely a tendency to bite, or to fits of uncontrollable 
fury. In this stage the danger is from licking rather than from 
biting. 

After a time comes a fit of maniacal fury, generally provoked 
by the sight of another dog. When this subsides he becomes 
controllable again, but is disposed to wander from place to place. 
With a slinking appearance, head and tail down, eyes bloodshot, 
and with foam at his mouth, he trots along snapping and biting at 
imaginary objects. He is aggressive only when attacked, but his 
fury is then unbounded. He drinks water eagerly and will try 
to drink when swallowing becomes difficult or impossible. He 



EMERGENCIES. 205 

seems entirely insensible to pain, dashes himself against his ken- 
nel, and has been known to seize and hold a red hot poker in his 
mouth. When tired out from hunger and wandering he drops ex- 
hausted in some out of the way corner, to start again after a short 
rest, and finally dies from exhaustion. The average duration of the 
disease in the dog is five days; it never exceeds ten, after the 
first symptoms appear. 

Symptoms of Hydropliobia in Man. — The first symptoms ap- 
pear in the wound itself. It becomes red and tender, with sensa- 
tions of uneasiness, itching, or even of pain. The patient becomes 
irritable and melancholic, and his sleep is disturbed. The first defi- 
nite symptom is a sense of tightness and choking in the throat, 
with slowness in swallowing, especially in swallowing liquids. 
There is inflammation and great dryness of the throat. On at- 
tempting to swallow, the patient becomes agitated, hesitates, then 
drinks a very small quantity, or none at all. "The difficulty in 
swallowing rapidly increases and the act soon becomes impossible. 
Next, the breathing becomes difficult and painful, with a sense 
of want of air, or of impending suffocation. Indeed, the most 
marked symptoms are spasms of the muscles of the throat and 
neck, by which swallowing is prevented and breathing interfered 
with." The voice becomes dry, hoarse and spasmodic — often giv- 
ing rise to reports that the patient growls like a dog. Shuddering 
tremors run through the whole body, and a fearful expression of 
anxiety, terror and despair is depicted in the countenance. Froth- 
ing at the mouth is rare, but mucus collects in the throat, occa- 
sioning hawking and spitting. 

The pulse becomes feeble and rapid, and the temperature 
goes up to 102 degrees or 103 degrees. The mental faculties are 
but little impaired. "To a bystander, the most distressing feature 
of the case is the fear of impending death, which is usually mani- 
fest after the first attack, and remains throughout the whole course 
of the disease. 1 ' The distinction between hydrophobia and lock- 
jaw is one that is not always easy to make. Death occurs from 
complete exhaustion, its immediate cause being lack of air from 
spasm in the throat. 

Treatment. — There are various methods of treating hydro- 
phobia, most of which are wrong. Before detailing the proper 
treatment, it seems necessary to mention one very improper treat- 
ment; namely, the application of the so-called mad-stone. The 



206 EMERGENCIES. 

subject of mad-stones is never mentioned in works written for 
physicians, for such a mention would be an insult to their intel- 
ligence. But it may be that there are yet in America persons so 
benighted as to believe in the efficacy of the mad-stone, although 
it is only a relic of barbarism — of the time when our ancestors 
lived in caves, wore the skins of wild animals and worshiped idols. 
It is on a par with the fetich of the cannibal, the voodoo of the 
African, and the rabbit's foot of the American negro ; and belongs 
to the same category as wearing a rattlesnake's skin next the body 
for rheumatism, blowing a silk handkerchief through chest wounds, 
and putting camphor in the baby's coffin. to dry up the mother's 
milk. 

The so-called mad-stone is either a porous stone of volcanic 
origin, or an accretion stone; such as is sometimes found in the 
stomach of ruminating animals. In either case it is porous like a 
sponge, and is usually prepared for use by boiling in milk, though 
boiling in water or heating in an oven would serve the purpose 
quite as well — which is to drive the air out of the pores of the 
stone by the action of heat. It is then clapped on the wound and 
the vacuum, produced in the pores of the stone by cooling, causes 
it to cling to the raw surface and absorb blood and the juices of the 
flesh until the vacuum is overcome and the stone drops off. It 
is thus seen that the mad-stone does possess some slight absorp- 
tive power, and, if immediately applied to the wound, might pos- 
sibly absorb some of the virus, though cupping or a moist sponge, 
tightly squeezed just before its application, would be better, and 
suction by the mouth would be very much better ; but when several 
hours have passed before the stone is used, it can be of no possible 
value. The poison has then entered the blood and been carried 
to all parts of the body, and to attempt to draw it from the wound 
is as useless as to try with a sponge to sop up milk that was spilled 
on soft ground yesterday. 

Someone says that if it does no good it can do no harm. 
But it does do harm; and in this way: It gives the patient a 
false sense of security and prevents him from employing intel- 
ligent and efficient methods of treatment, until forever too late. 
To use it is to forsake common intelligence, and lose precious hours 
in foolish voodooism, thus giving the poison time to spread 
through the system, and get such a hold that even scientific 
treatment will be powerless to overcome it. It is certainly time 



EMERGENCIES. 207 

that such ignorant and childish beliefs should be abandoned, and 
hydrophobia treated with the same degree of intelligence that we 
employ in treating small-pox, malaria, diphtheria and other dis- 
eases. 

In case of a rabid dog bite there is but one course to pursue. 
The wound should be sucked as soon as possible, by one without 
any badly decayed teeth, or any sores in his mouth or on his lips, 
then immediately cauterized. The cauterizing may be done by 
a poker, nail or any other small iron heated to redness. It may 
also be done with caustic soda, caustic potash, nitrate of silver, or 
nitric acid, but actual cautery with the hot iron is better and less 
painful, and can be placed in the exact spot better. The iron 
should be thoroughly applied and carried well down to the' bottom 
of every part of the wound, but care must be taken not to need- 
lessly burn a larger surface than was injured by the bite, and to 
then quickly cover the wound with absorbent cotton or some 
other antiseptic dressing to keep out pus producers, and other 
germs, lest by making a sore that shall become covered with 
scabs, the spread of any remaining virus be promoted instead of 
prevented. 

The very best remedy that can next be used is fresh lemon 
juice, two or three times a day. Wipe a lemon clean and cut 
a hole in it with a clean knife ; then, without touching the wound, 
squeeze the lemon over it, dropping the juice into it until the 
wound is saturated. Then replace the antiseptic dressing. Mean- 
while, the patient must lose no time, but as soon as possible reach 
an institution where he can receive the Pasteur treatment. There 
is nothing more certain in the whole range of medicine than that 
this treatment will, if taken soon enough, prevent hydrophobia. 

As already stated, there is no record of a singJe case of hydro- 
phobia that ever recovered under any treatment, and as two- 
thirds of all those bitten take the disease, we may say that the 
death rate with all treatments besides the Pasteur is about 67 per 
cent. The records of the original Pasteur Institute in Paris show 
that by its method the death rate was reduced to a small fraction 
of 1 per cent. The treatment is so complex and requires such 
great skill and care that it can be administered only in an institu- 
tion specially prepared for it. There are Pasteur institutes in 
all the great cities of Europe, and one in Xew York, one in Balti- 
more and one in Chicago. Although care is used to receive 
no patients except those bitten by animals known to be rabid, 



208 EMERGENCIES. 

or strongly suspected of being so, the treatment has failed to 
prevent hydrophobia in only about one-third of I per cent of 
the many hundreds treated at the Pasteur Institute in Chicago 
and, doubtless, these would also have been saved had they arrived 
in time. 

Unless the animal inflicting the bite is positively known to 
be rabid, it should not be killed, but carefully confined where it 
can do no harm. If it does not die within fifteen days it is cer- 
tain that it was not rabid at the time of the biting. The popular 
idea that if a dog goes mad at any time longer than fifteen days 
after biting someone, he was probably mad at the time of the 
biting, is wholly wrong. No dog lives longer than ten days 
after showing the first signs of rabies. Pasteur proved that a 
dog carries the poison in his mouth seven days before showing 
any signs of the disease, a fact that has since been verified by 
other investigators. Never allow a dog to lick the hand if there 
be upon it any sore, scratch or abrasion of the skin. 

Hydrophobia chiefly affects the nervous system, notably the 
spinal cord and brain. A healthy animal inoculated with virus 
taken from the spinal cord of one suffering with hydrophobia 
soon develops the disease, but if the affected spinal cord be re- 
moved from the body and slowly dried in an incubator kept 
at a uniform temperature of yo degrees, its virus gradually loses 
its strength until in fifteen days it becomes so weak as to be able 
no longer to produce the disease. The Pasteur treatment con- 
sists of a series of inoculations, beginning with virus that has 
thus been dried fifteen days, and each time using virus that has 
been dried one day less and is therefore a little stronger than that 
used the preceding time, thus gradually bringing the system to 
a toleration of the poison, until it is rendered immune, i. e., inca- 
pable of being injured by direct injections of the strongest virus 
of hydrophobia. The time required in which to give the treat- 
ment is fifteen, eighteen or twenty-one days, according to the 
severity of the case, and the sooner after the bite it is given the 
better the chances for the patient. To this phenomenon, of the 
system gradually accommodating itself to a poison, and the won- 
derful fact that the virus works more slowly when communicated 
through the saliva of the animal inflicting the bite than when 
taken from its nervous tissues and injected into the subdermic 
tissues of the patient, any person may sometime owe his deliv- 
erance from a dreadful death. 



BACTERIA. 

By L. C. Duncan, M.D. 

In 1675 Leeuwenhoek, a Hollander, by the aid of single 
lenses, first saw the minute forms of life which we call bacteria. 
He found them in saliva. A little later, the compound microscope 
having been perfected, putrid liquids were shown to swarm with 
organisms so minute that millions were held in a single drop, 
but it is not known if he associated these germs with the causa- 
tion of disease. It is thought, however, that the man who first 
conceived the cause of disease to be a living contagion was the 
Roman Varro, who lived in the time of Caesar. In one of his 
books he says: "If there be any marshy places, certain minute 
animals breed there which are invisible to the naked eye, and 
yet, getting into the system, cause diseases difficult to treat." 
He evidently had in mind malaria, which we now know is caused 
by just such "minute animals." It was almost 2,000 years before 
the idea was again taken up, and Henle, in 1821, proposed the 
germ theory of disease. Of course it aroused opposition, but 
every objection was met and overcome. 

Latour and Schwann proved, in 1837, the active principle 
of yeast to be a minute vegetable form of life, since known as 
the yeast plant. In 1849 Pollander discovered the germ of 
anthrax (the splenic fever of animals), and in 1863 Davaine 
proved by inoculative experiments that this bacillus produces 
the disease. In 1862 Pasteur showed that many forms of life 
float about in the air, and in 1872 Klebs taught that blood poison- 
ing is caused by bacteria. The next year Obermeier discovered 
the germ of relapsing fever, and by 1875 the germ theory had 
secured general recognition. It was in that year that Lister 
proposed the use of substances that would either prevent the 
growth of the bacteria of disease or destroy them. The former 
substances are now known as antiseptics, the latter as disinfect- 
ants. He began with the use of solutions of carbolic acid in his 
surgical operations and immediately revolutionized surgery. 
This was the first, and it still remains the greatest practical 
application of the germ theory of disease. 
14 209 



210 BACTERIA. 

In 1879 Hanson discovered the bacillus of leprosy and Neiser 
the micrococcus of gonorrhea. In 1880 Eberth and Koch dis- 
covered the bacillus of typhoid fever, Pasteur the bacillus of 
chicken cholera and Sternberg the bacillus of pneumonia. In 
1882 Koch made the greatest discovery of them all, by finding 
the germ which causes consumption, scrofula, joint disease, Potts' 
disease, lupus and all the other forms of tuberculosis — a disease 
which destroys one-seventh of the human race. 

In 1884 Koch discovered the spirillum of cholera. Loftier 
the bacillus of -diphtheria, and Nicolaier the bacillus of tetanus. 
In 1892 PfeifTer found the bacillus of influenza or la grippe. In 
1894 Yersin discovered the germ of the Eastern bubonic plague, 
and in 1897 Sanarelli reported the discovery of the bacillus 
of yellow fever, but it has never been made to comply with all 
the tests required in such investigations. Cancer and syphilis 
are two other diseases evidently of bacterial origin, but though 
sought long and carefully, their germs have not yet been found. 

GERM CAUSATION OF DISEASE. 

That there should be no doubt that a certain germ causes 
a certain disease, Henle and Koch laid down four laws : 

1. The germ must always be found associated with the 
disease. 

2. It must be found in the living body. 

3. It must be obtained from the body and grown on culture 
media, uncontaminated with other germs. 

4. These separated germs, when injected into another per- 
son in sufficient quantities, must produce the disease. 

Unless the germ fulfills all of these four conditions it cannot 
be said to be the cause of the disease. 

The germ causation of infectious diseases is now universally 
believed by scientific men, and, since the germs of most dis- 
eases have been found, efforts at present are not so much in 
the line of discovering new germs as in new applications of our 
present knowledge. If the germs which cause disease are living 
bodies, we have only to destroy them to prevent or stop disease. 
The question is, how to destroy them, or at least how to stop 
their action. It has been found that a 'number of chemicals, 
such as bichloride of mercury, carbolic acid and alcohol, will do 
this. In surgery these antiseptics applied to a wound destroy 



BACTERIA. 211 

the germs there, and in this way suppuration, blood poisoning, 
hospital gangrene, erysipelas, tetanus and other complications 
may be prevented. With these dangers removed the surgeon 
dares to enter the abdomen, stomach, lungs, brain and other 
parts of the body, heretofore sacred ground ; in fact there is 
scarcely any part of the human anatomy that the surgeon of 
to-day fears to touch with his knife. 

In medicine, progress has not been as gratifying, for although 
several diseases have been conquered many yet remain. Obvi- 
ously, in the case of a general disease, strong chemicals cannot 
be introduced into the body in sufficient quantities to destroy 
the germs without also destroying the life of the patient. Hence 
investigators have sought a cure in the bacillus itself, or in its 
products. Since a person who has once had a certain disease, 
as yellow fever, does not usually have it again, it is thought that 
the disease must leave some substance in the blood which renders 
it an unsuitable habitation for that particular germ. The diffi- 
culty is to find and secure that substance, toxine or antitoxine, 
whatever it may be. 

Behring and Roux were the first to succeed in this field. 
By inoculating a horse with diphtheria they prepared an anti- 
toxine from its blood which, on being injected into the arm of a 
healthy child, will" prevent diphtheria from one to two months, 
and, if injected early enough, will cure most cases of the disease. 
(See Diphtheria.) In the same way an antitoxine for tetanus 
has been prepared, though not yet an unqualified success, and the 
Pasteur treatment for hydrophobia is somewhat on the same 
general plan. (See Hydrophobia.) 

A most valuable addition to our knowledge of diseases is 
promised in the treatment of cancers and other tumors by the 
toxine of erysipelas. Since it has been found that some germs 
prey upon others, or, more properly, the toxine produced by 
one variety is fatal to those of some other varieties, the happy 
idea has taken shape that the germs of a mild disease may be 
set upon those of a fatal disease and made to destroy them. 
Dr. Coley of New York has cured a number of cases of cancer by 
inoculating the patient with the toxines of diphtheria ; but others 
have tried the plan with little success, and it is still in the experi- 
mental stage. 

The only diseases that have thus far been successfully prevented 



212 BACTERIA. 

or treated are small-pox, diphtheria and hydrophobia ; but, know- 
ing the cause, we know how to stamp out all infectious diseases ; 
all we lack is the power. Had we authority to handle every case 
of typhoid in accordance with our best knowledge, we could pre- 
vent in each case the escape of any typhoid germs to produce 
other cases, and in a comparatively short time typhoid fever 
would be banished from the earth. So with scarlet fever, yellow 
fever, tuberculosis, and all other infectious diseases. Since we 
have not the power of banishing them we must seek means of 
curing them. The child does not fear until it is hurt; the adult 
fears first and avoids the hurt. Society, apparently, is still in the 
child-like stage, but the time is coming when disease and crime 
will be prevented, instead of being permitted to develop and 
harass and destroy their victims. 

Even doctors are often heard to speak of germs of disease 
as "bugs," thus conveying the impression that they are animals. 
This idea is false, for with few exceptions they are minute vegeta- 
ble forms of life, the only exception of importance being the 
germ of malarial fever, which belongs to the group of protozoa — 
the lowest form of animal life. 

Definitions. — In common use the terms germs, bacteria and 
microbes are used interchangeably, but there are many other 
names given them, descriptive of some particular characteristic, 
for germs are classified according to their form, etc., thus: 
(i) Micrococci, usually called cocci, are those germs which are 
ovoid like an egg or round like a marble; (2) Bacilli, those rod- 
shaped, like a pencil ; (3) Spirilla, the varieties shaped like a spiral 
or corkscrew. 

Again there are modifications of these classes, according to 
the mode of grouping, thus : Diploco.cci always occur in pairs, 
tetrads in fours, staphylococci in clusters like grapes, streptococci 
in chains, sarcina in cubes. A bacillus may be straight or curved ; 
square or rounded at the ends, or enlarged at one or both ends. 
Most disease germs are bacilli. 

Size. — Bacteria are so minute that they can be seen only with 
the highest power of the microscope. Figures convey little 
idea of their size. The tubercle bacillus, larger than many, is 
T¥ 000 of an i ncn long and 50 roo of an inch thick. Of the 
average bacilli it is estimated that 6,000 billions would be re- 
quired to weigh a grain. Bacteria are also of such trans- 



BACTERIA. 213 

parency that it is exceedingly difficult to study them until 
stained. The discovery by Weigert in 1877 that these little 
bodies have such an affinity for the coloring matter of aniline 
dyes as to take a deeper stain than the substances or media in 
which they are found was a great step in their investigation, and 
it will be noticed that it is since that date that most of the varie- 
ties have been isolated, that is, studied separately and the 
peculiarities distinguishing each variety pointed out. 

HOW BACTERIA GROW AND MULTIPLY. 

Many varieties of bacteria reproduce their kind in two 
ways : By fission (division) and by spores. In reproduction by 
fission, around the parent germ a little pale line may be seen 
which grows deeper until the two portions are entirely separated, 
each thereby becoming a complete organism, which in turn by 
division, like the parent from which it came, also multiplies 
itself by two. As, by thus dividing once an hour, a single germ 
and its progeny may increase to over sixteen and a half millions in 
twenty-four hours, the rate of increase under favorable conditions 
is seen to be wonderful ; the more so when it is remembered 
that they have been known to divide as often as once in twenty 
minutes. It does not often happen that all of the conditions 
are favorable to their most rapid development. Temperature 
is a most important factor. It must not be less than about 
61 degrees or greater than 104 degrees Fahrenheit. Cold prevents 
the multiplication of bacteria but does not destroy them, and, 
while they may be rendered dormant by a 1ow t temperature for a 
long period of time, they awake to renewed activity and virulence 
as soon as the proper degree of heat is supplied. On the other 
hand, a sufficiently high temperature destroys all kinds of germs, 
the degree required for this purpose varying, according to Stern- 
berg, from 129.2 degrees to 158 degrees Fahrenheit, in streaming 
steam ; but boiling is the surest method. 

Moisture is quite as important as favorable temperature 
to germ development, for its presence is absolutely necessary. 
When deprived of moisture, most vegetable germs, in drying, 
change their form, thicken their covering or skin, and become 
what are called spores, in which condition they may lie dormant 
indefinitely, unless moisture and warmth be supplied in the right 
proportions, when they again become germs, and, like their 



214 BACTERIA. 

ancestors, multiply rapidly. Specification may also take place at 
other times, especially when the food supply becomes exhausted, 
or when, by means of the poisonous products formed by the 
germs themselves, it is changed into an unsuitable medium for 
their sustenance. 

Spores are able to offer much greater resistance than bac- 
teria to destructive influences ; they withstand higher tempera- 
tures and the action of most poisons, and, as long as deprived 
of a combination of moisture and proper temperature, cannot 
germinate and are practically immortal. It requires boiling, often 
for twenty minutes, and sometimes longer, to destroy them. 
Careful experiments with spores taken from cavities in petrified 
wood, where they had lain no one knows how long, probably 
hundreds of years, resulted in their growing as perfectly as had 
they been but a few days old. Again most germs thrive best in 
the dark, and to many species bright sunlight is fatal. 

THE UNIVERSAL PREVALENCE OF BACTERIAL GERMS. 

Germs are everywhere, in the air we breathe, the soil we 
tread, the water we drink, the food we eat, the clothes we wear, 
and in the skins covering our bodies. Fortunately only a com- 
paratively few species are injurious to man ; some varieties are 
even thought to aid digestion by supplementing the action of 
the digestive juices; and many forms seem to live to prey upon 
other forms, the conflicts in the microscopic realm being quite 
as real as those waged in the visible world. 

HOW BACTERIA PRODUCE DISEASE. 

Most of the disease-producing bacteria do their deadly work 
not by directly attacking living tissues, but by producing fer- 
ments called toxines or ptomains, which by absorption are 
taken into the blood and thus enabled to spread their poisonous 
effects. One variety shows an affinity for certain parts, others for 
others, and their presence in each' case is manifested by the 
symptoms of the disease thus produced. So often and so posi- 
tively have certain well-known varieties been proven the causes 
of certain diseases, that the physician now depends largely upon 
them for his diagnosis, and, by so doing, is able to determine 
the exact nature of the ailment at an earlier stage of its devel- 
opment than would otherwise be possible. By placing a minute 



BACTERIA. 215 

portion of the diseased tissue, or of the secretions or excretions 
of the patient, in a preparation of gelatin, broth., seaweed, or 
other substance in which the suspected microbe is known to 
thrive, and supplying the conditions favorable to germ devel- 
opment, care having been taken to exclude germ life from all 
other sources, "a culture'' is soon obtained, in many cases unmis- 
takably revealing the character of the disease. 

THE PUTREFACTIVE PROCESSES. 

It is certain that the putrefactive processes are due to a few 
kinds of these bacteria which are widely disseminated and abound 
upon the objects all about us, and. as putrefaction hinders if it 
does not entirely prevent the healing process, it is most important 
in the dressing of all wounds that we understand the tiny foes 
with which Ave have to deal and the measures necessary to outwit 
or overcome them. Indeed, in healthy persons, when the proper 
precautions have been taken to exclude all kinds of germs, the 
most extensive cuts made by the surgeon very quickly heal 
without any sloughing or pus. 



MINOR SURGERY. 

OR FIRST AID TO THE INJURED. 
By J. C. McClintock, A.M., M.D. 

In the war with Spain the American soldiers were supplied 
with emergency or first aid packets before going to the front. 
They were put up by several firms and differed somewhat in 
their contents. Those furnished to the Illinois volunteers were 
devised by Senn, and consisted of about a teaspoonful of powder 
composed of one part of salicylic acid and four parts of boracic 
acid; one dram of absorbent cotton containing the powder in 
its center; a piece of sterilized gauze about forty inches square, 
and several safety pins; the whole wrapped in gutta percha. 

Those put up by Johnson & Johnson, New Brunswick, N. J., 
contained two small gauze compresses, a roll of bandage, two 
safety pins and a triangular bandage on which were illustrations 
showing how to bandage every part of the body, all inclosed in 
oiled linen, and so prepared as to be absolutely free from germs 
of every kind. Each man was instructed to open his packet 
only in an emergency, but on receiving a wound to place one 
of the compresses upon it as soon as possible, to apply the anti- 
septic bandage over the compress, and to then use the triangular 
bandage as shown by the illustrations on the same. By follow- 
ing these directions, nearly every wounded man recovered, not, 
as many have supposed, because of the less serious wound made 
by the modern high power gun, but because the pus germs were 
thus shut out and the wound kept pure by the occlusional dress- 
ing until it could receive a permanent dressing at the hands of 
the surgeon. 

Surgeon Newgarden, in speaking of the hospital work at 
Bloody Ford, Santiago, says: "Before the battle opened many 
of these packets had been thrown away by the thoughtless as 
being so much unnecessary encumbrance; but later, so high did 
they rise in the estimation of the men, I several times heard 
them trying to buy of one another, but without success. They 
evidently realized the value of the packet then. Small and almost 

217 



218 MINOR SURGERY. 

insignificant as it appeared before the fight, it really was one of 
the most important parts of the equipment, next to the actual 
munitions of war and commissary supplies. We owe directly to 
its prompt use the low mortality from wounds and the small 
number of amputations necessary. Many injuries which were 
not disturbed for some days after this first dressing was applied 
were found completely healed, and required no more care, when 
the dressing was removed, for the purpose of putting on a fresh 
one.'' 

There could hardly be a clearer demonstration of the 
value of the discovery of the germ causation of suppuration and 
sloughing than is found by contrasting this scientific treatment 
with the murderous neglect inflicted upon brave heroes in all 
our former wars, when, left in many cases for two or three days 
upon the battlefield, their uncared-for wounds became terribly 
swollen and inflamed, if not horrid masses of suppuration and 
gangrene, before reaching the surgeon. 

Packets, similar to those used in the army, are now put 
up by several manufacturers of antiseptic dressings and sold for 
about twenty-five cents each. They should be kept in every 
home. No family can afford to be without one. A box of 
antiseptic cotton, never to be opened until needed, and a bar 
of carbolic soap should also be on hand against emergencies. 
Any clean soap will do, but carbolic soap is the best of any 
that can be readily obtained and easily preserved. 

PUS GERMS. 

Of the few varieties of germs which are pus producers, each, 
on entering the blood or tissues, forms a product peculiar to 
itself. The most common is that called staphylococcus aureus. 
It produces a yellow or whitish yellow pus and is the chief factor 
in four-fifths of all cases of suppuration. Its germs are very 
widely distributed, being found almost everywhere, in the soil, 
on objects all about us, upon our clothing, our hands, and 
especially in. the accretions under the nails, but not often in 
air that is free from dust. 

The staphylococcus albus is the next most important variety, 
and produces a white pus. Although its germs occur everywhere, 
they most abound in the deep follicles of the skin, and are nearly 
always troublesome in surgical cases in which proper precau- 



MINOR SURGERY. 219 

tions were not used prior to the operation. A thorough scrubbing 
of the skin at and around the places where cutting and stitching 
are to be done are the measures for. avoiding them. The varie- 
ties which severally produce green, red and blue pus are less 
common and need only be mentioned here. 

SURGICAL CLEANLINESS. 

To the surgeon the words "clean" and "cleanliness" mean 
that which is "surgically clean" — free from foreign matter and 
all pus germs — a condition so important that first of all, unless 
there be such severe hemorrhage as to demand immediate atten- 
tion, the hands of any person_about to do up a wound should be 
made clean by thoroughly washing with clean soap and water.' 
As the ordinary washbowl and soapdish, even when apparently 
clean, are generally very unclean, teeming with the very germs 
to be avoided, it is safer for this purpose to use almost any other 
basin or pan, it having first been carefully washed and scalded. 

Having thus prepared the hands, do not try to wash or 
cleanse the wound, except to remove from it all bits of clothing 
and other foreign matter, using great care not to soil the wound. 
Next take the gauze compress from the packet, and without 
allowing anything but the clean hands to touch it, place it over 
the wound, cover with a layer of antiseptic cotton thick enough 
to absorb all the blood and serum likely to be discharged, and 
over all wrap the bandage, drawing it firmly if there is much 
bleeding, but not so tightly as to obstruct the circulation in the 
parts beyond. The surgeon seldom uses less than a half pound 
of cotton to cover a wound and absorb its discharges. Only 
cotton that has been antiseptically prepared is fit for this purpose. 
Should the bandage be found too snug it may be loosened 
a little, but the gauze and cotton should not be disturbed until 
preparations are complete for the permanent dressing. 

If the patient is suffering from shock, or is faint, very weak 
or pale, he should be put to bed and surrounded by bottles of 
hot water, securely corked and wrapped in cloths to prevent blis- 
tering the patient. Mason fruit jars, carefully sealed, are excel- 
lent for this; jugs serve the purpose well. The clothing about 
the neck, chest and waist should be loosened, if not removed. If 
ammonia be applied to the nostrils it must be quite dilute and used 
for only a short time. Do not use large pillows; the horizontal 
position is best. 



220 



MINOR SURGERY. 



THE TEMPORARY DRESSING OF WOUNDS. 

Many lives have been lost because of fright at the sight of 
blood. Paralyzed with fear, the doctor's coming has been help- 
lessly awaited until too late, when the patient, or anyone else, 
by pressing the right spot, could have stayed the crimson current 
until the arrival of more skillful aid. No one need bleed to death 
unless wounded in more places than he can reach with his fingers 
and thumbs. 



HEMORRHAGE. 

The temporary con- 
trol of hemorrhage is ef- 
fected by direct pressure 
in the wound, or by pres- 
sure upon the blood ves- 
sels above or below the 
wound. To control hem- 
orrhage directly in the 
wound, wipe out the clots 
with a piece of clean ab- 
sorbent cotton and im- 
mediately fill the wound 
with another piece of dry 
cotton, pack it in, and 
pile it up over the wound, 
then firmly bandage over 
all. Should the hemor- 
rage persist, take out the 
cotton, repack the wound 
with fresh cotton, and ap- 
ply the bandage much 
more tightly than before, 
if necessary using addi- 
tional pressure over the wound with the hand. 

If the bleeding be from an artery, it will come from the side 
of the wound next the heart, and will be controlled by pressure 
between the wound and heart upon* that artery. This pressure 
will be most efficiently applied at the points shown in Plate V. 
If the bleeding be from a vein, it will come from the side of the 
wound furthest from the heart, will be darker in color than bright 




To Prevent Bleeding from the Femoral Artery at 
any Place in the Limb Below the Point of Pressure. 



FOR HAND 



OR 




HAND S 



FOR FACE 
FOR ARM 







FOR FOREHEAD 



FOR SCALP 



FOR NECK AND HEAD 






(heart j 



v / 



FOR THIGH 



FOR TOP OF FOOT 




FOR SOLE 
OF FOOT 



PLATE V. 

Points at which pressure controls Arterial Bleeding. 



■MINOR SURGERY. 



221 



red arterial blood, and will be controlled by pressure on the vein 
on the side of the wound furthest from the heart. The pressure 
can often be exerted upon the selected point by applying the 
hand thereon and throwing the weight of the body upon the 
hand, the weight to be sufficient to control the hemorrhage. 

A better way is to cut or tear a half yard or more of gauze 
or muslin into strips three or four inches wide, wind them into a 
firm roll, apply it to the selected point, and over it wrap a 

bandage very tightly: 
If it be found impos- 
sible to thus bind the ar- 
tery tightly enough to 
arrest the hemorrhage, 
try a tourniquet or 
"Spanish windlass," i. e., 
tie a strong bandage 
loosely about the limb, 
place the compress over 
the selected spot and un- 
der the bandage, then 
with a cane or similar 
lever thrust through the 
bandage, twist it round 
and round until the 
bleeding stops. Where a 
compress roll cannot be 
quickly obtained, a ball 
of any kind, a smooth 
stone, a block with 
rounded corners, or even 
an apple or potato may be used under the tourniquet bandage 
to press upon the artery or vein. 

Should all these devices prove insufficient, a piece of strong 
one-fourth to one-half inch elastic rubber tubing can be wound 
several times around the limb, without any compress, tightly 
enough to control hemorrhage under any circumstances. If 
resort to either of the last two methods is required, a surgeon 
must be summoned immediately, and the limb be left bound but 
a few hours, for cutting off the circulation too long may result 




The Tourniquet Applied to the Arm. 



222 



MINOR SURGERY. 




The Tourniquet Applied by an Assistant to Prevent Arterial Bleeding in the Leg. 

i-n gangrene, possibly in death. These measures, therefore, are 
to be employed only as a last resort, when the other means have 
failed, but must be used rather than let the patient bleed to death. 




The Tourniquet Applied by the Patient Himself. 



As soon as the hemorrhage has been controlled, the wound 
should be given a temporary dressing as already described. 



MINOR SURGERY. . 223 

THE PERMANENT DRESSING OF WOUNDS. 

The permanent dressing should be applied as soon as proper 
preparations can be made, and, for obvious reasons, this should 
be done by a surgeon. To enable him to secure perfect cleanli- 
ness, from two to four gallons of pure water should be provided. 
It is best prepared by boiling twenty minutes, (then cooling in 
the same vessel, until comfortably warm for the patient. If the 
time be limited, it is better to boil it in several small kettles, that it 
may thus cool more quickly than it would in one large one. If, how- 
ever, the water is pure enough to be good drinking water, boiling 
is not very important, for it will contain so few disease germs 
as to be practically clean. One or two dozen freshly laundered 
clean towels, a bar of carbolic soap, or better still, some of 
the green soap known as saponis viridis, a small hand-scrubbing 




To Suppress Arterial Bleeding Below the Knee. 



brush of vegetable fiber, and a clean basin should also be provided. 

A table is a much better place than a bed for the patient to 
lie while his wound is being dressed. It should be covered by 
two or three thicknesses of comforts, or by several blankets, and 
a clean sheet spread smoothly over them, the patient laid thereon, 
a clean sheet spread over him, and blankets also if the room 
be cool, exposing only the wounded limb during the dressing. 
The table and everything about it, and the patient and every- 
thing about him, must be clean, and the site of the wound and 
its surrroundings must be especially clean. 

Both operator and assistant should first prepare by cutting 
their nails as closely as they can be trimmed, and scrubbing their 
hands and fingers thoroughly, especially about the nails, then 



224 MINOR SURGERY. 

rinsing in clean water until rid of every trace of soap. All prep- 
arations having' been properly made, the assistant will remove the 
old dressings and render such other aid as will enable the operator 
to work with surgically clean hands. 

FRACTURES. 

A fractured bone is a broken bone, and is caused by violence 
applied either directly at the place of fracture, or to the ends 
of the bone so that a break is made at some point between them. 

Symptoms.' — Pain, following violence, at and about the site 
of the injury; the patient may have felt or heard the crack when 
the injury occurred ; frequently a crackling or grating sound is 
produced by the rubbing together of the broken ends. There 
is deformity, usually a shortening of the injured limb, and a 
bending from its natural line. Swelling adds to the deformity, 
and there is likely to be the red or blue discoloration, often termed 
"black and blue," caused by bleeding into the tissues beneath 
the skin. Often, but not always, when the limb is moved there 
seems to be an extra joint — a point of motion where there should 
be continuous bone. Loss of all strength or force does not often 
occur, the patient usually being able to move his fingers and toes. 

The first thing to do is to "keep cool," then bare the limb with- 
out bending it, either by carefully slipping the clothing from it 
or by neatly ripping up the seams and turning it back; sacrifice 
the clothing only when necessary to avoid bending the limb. 
Next, the limb should be drawn into a straight natural position, 
and as many splints applied and carefully but firmly bound to 
the limb as may be required to hold the fractured ends rigid and 
immovable, for there is great danger lest even slight movements 
of the sharp broken ends lacerate the surrounding tissues, sever 
an artery, injure a large nerve, or by pushing through the skin 
open the way for septic poisoning. Almost any stiff object of 
suitable size may be used as a splint; a board, cane, umbrella, or 
even a stiff cornstalk will serve the purpose in an emergency. 
Use the stripped off clothing as padding to prevent the ends 
of the splints from injuring the limb. 

In case of a fractured leg, unless an ambulance be at hand 
for conveying the patient to his home, or other refuge, a stretcher 
should be improvised from a board, door, shutter, or something 
similar. If held by enough hands to keep it from sagging too 



MINOR SURGERY. 225 

much, a strong blanket makes a good stretcher. If there be 
only two bearers and a blanket is at hand, it may be made into a 
sling by placing the patient on the blanket and tying its corners 
together over him, then, by means of a pole, rail or strong board 
thrust under the part of the blanket covering the patient, he 
may be safely borne upon the shoulders of his friends. In any 
case, the bearers should keep step at an easy, swinging pace, 
to cause as little jarring as possible, or, if the distance be long, 
they may stand in a wagon and hold the stretcher in such a w T ay 
as to prevent all sudden jolts. Let every precaution be taken 
against disturbing the injured limb, or grating the fractured ends 
upon each other. 

From the stretcher the patient should be transferred to a 
narrow bed, that the surgeon may have access from either side ; 
it should be rather hard and without springs, a board having 
been placed beneath the mattress to prevent sinking down in the 
middle. 

Do not get excited. An ordinary fracture is not a dangerous 
accident. It should be reduced as soon as possible, but time is 
not the element of greatest importance, and it is better to await 
the coming of the surgeon of your choice than to send in every 
direction and get several, then have no one to take the individual 
responsibility of making a perfect limb. 

Reducing the fracture, or "setting the bone," is bringing 
the broken parts together in their natural position and retaining 
them there by proper splints and bandages. Make no attempt 
to set the bone, but keep the injured place covered with cloths 
wrung frequently from clean cold water, and await the surgeon's 
coming. 

Repair occurs when the fractured ends are brought together 
in the proper position and condition, and held there perfectly 
still by the aid of splints, usually two in number, bandaged to 
the limb. The length of time required is considerably influenced 
by the health and age, but usually is from six to eight weeks. 

SPRAINS. 

A sprain is an excessive strain of the muscles or ligaments 
of a joint, without dislocation. 

A sprain may be of any degree of severity, from one of little 
consequence that recovers in a few days without any treatment, to 

15 



226 



MINOR SURGERY 



an injury of very great importance. The joint itself may have been 
torn open, or the ligaments about it so strained or torn as to 
produce serious permanent lameness. Hence, a sprain should 
not be regarded lightly, and, if the injury is apparently severe, 
a surgeon should be called and his directions followed. 

Treatment. — As soon 
as possible after the ac- 
cident immerse the in- 
jured joint in very warm 
water and hold it there 
from thirty minutes to 
an hour, keeping the 
water all the time, by 
frequent additions of 
very hot water, as hot 
as can be borne by the 
patient. Then, having 
carefully dried the limb 
in soft towels, cover the 
joint and limb for some 
inches above and below 
the injury with strips of 
adhesive plaster running 
lengthwise of the limb, 
after which cover that 
by winding a long strip, 
about three inches wide, 
of the same plaster, 
round and round the 
limb, drawing it snugly 
but not so tightly as to 
stop the circulation, and 
using care to make each 
turn slightly overlap the 
preceding one. This 
having been properly done, the patient may immediately resume 
the natural use of the joint. The modern surgeon does not advise 
resting a sprained joint, but that it be given moderate use from 
the first. Do not apply washes or liniments of any kind. 




Adhesive Bandage for Sprain. 



MINOR SURGERY. 227 

DISLOCATIONS. 

The displacement of a bone from its natural joint with another 
bone is a dislocation. 

Symptoms. — The general symptoms are a change in the 
shape of the joint; lengthening or shortening of the limb; pain 
in the joint and great difficulty or absolute impossibility of 
moving it. 

Treatment. — To reduce a dislocation is to restore the bones 
to their natural place, and usually this can be done by the surgeon 
only. This is especially true of a hip dislocation, the treatment of 
which would be almost impossible by anyone not possessed of 
special knowledge and training. In general, as soon as a dislo- 
cation occurs, a surgeon should be called, but frequently a dis- 
location may be reduced by an intelligent bystander through 
simply pulling the joint apart — having an assistant hold and 
steady the bone above the dislocated joint, while he pulls on 
the limb below the dislocation, and in the natural line of the limb. 
Often this will be followed by the reduction sought, the bones 
returning to their places and the pain being thereby immediately 
relieved. 

The shoulder dislocation can often be reduced by the operator 
pulling in line of the arm as it hangs by the patient's side, the 
assistant at the same time placing his hands in the arm-pit and 
lifting the shoulder upward and outward from the body. If the 
bone goes back into its socket with a snap it can safely be con- 
sidered as all right. 

If an attempt to reduce a dislocation is not successful, do 
not resort to violent measures, but await the arrival of the sur- 
geon, meantime constantly applying cold water to the injured 
joint, unless it has received an external wound also, in which 
case only a dry dressing of absorbent cotton should be applied. 

Y\ nen the dislocation has been reduced, the member should 
be put at rest for three or four weeks by bandaging or splinting 
the part, thus holding it immovable until the torn and injured 
parts about the joint have recovered. The larger joints, as the 
elbow, shoulder and hip, require from five to six weeks for repair. 

BRUISES. 

A bruise is an injury to the soft parts beneath the skin. 
When accompanied by an injury to the skin it is called a bruised 



2'48 MINOR SURGERY. 

wound. The most common causes are blows and falls. Bruises 
may be of any grade of severity, from a simple bruise of the 
muscles of an extremity, to the severe purification of internal 
organs. 

Symptoms. — Pain, discoloration and swelling followed by 
heat. In severe or extensive bruises great and even fatal prostration 
may follow. The blood vessels of the bruised part are likely to be 
torn so that there is bleeding into the tissues, thus giving rise 
to pain, usually of a dull, heavy, aching character, and accompanied, 
frequently, by a certain numbness. Swelling also occurs as a result 
of the bleeding. Later when this blood comes nearer the surface, 
it shows through the skin in what are ordinarily known as black 
and blue spots. At first the color is usually purple, changing 
after a few days to violet, brown, olive and green, and, lastly, to 
a yellowish hue which usually disappears within two weeks. 

Treatment. — If the bruised part be a limb, it should be ele- 
vated as much as possible, consistent with the comfort of the 
patient, to prevent bleeding from the torn vessels, for this bleeding 
into the tissues will be much freer, and the consequent swelling 
much greater, if the limb be allowed to hang low. 

Ordinary temperatures favor free bleeding ; either very cold or 
very hot applications should, therefore, be made to the bruised 
part. Cold should be given the preference, if agreeable to the pa- 
tient, and nothing is better than a bag of pounded ice, kept con- 
stantly applied ; should hot applications be more agreeable, they 
should be used instead of the cold, but whichever is chosen should 
be continued without interruption for several hours, during which 
time the very low or very high temperature should be steadily 
maintained by rapid and frequent changes of the applications. 

If the swelling unduly increases, or if the limb becomes cold 
beyond the bruised part, or if the bruise be in the body and ac- 
companied by prostration, a physician should be called without 
delay. To overcome such prostration, the patient should be placed 
as soon as possible in a warm bed, given a hot drink, and sur- 
rounded with bottles or sealed fruit jars of hot water, but not of 
water so hot as to burn, for a patient in this condition may be 
so numb as not to feel even severe burning. 'Quiet must be 
maintained for several clays, and twice daily the bruised part should 
be gently rubbed towards the body. 



MINOR SURGERY. 229 . 

HERXIA. 
(Rupture). 

A hernia or rupture is a tumor formed by the protrusion of 
contents of a cavity through its wall, the external skin usually 
remaining unbroken. Its most common sites are the navel and 
groin. If at the navel, it is called an umbilical hernia. This form 
is very rarely found except in new-born children and fleshy women 
who have borne children, and whose abdominal walls have thereby 
been thinned out and weakened. 

A hernia in the groin occurs either just above or just below 
its fold (Poupart's ligament). If above, it is an inguinal hernia 
the form most common in boys and men, and if the protrusion 
continues until it pushes down into the scrotum it is a scrotal 
hernia. If it occurs below the fold in the groin, it is a femoral 
hernia, almost the only groin hernia that occurs in females. In the 
very rare cases in which the protrusion pushes down into one of the 
labia, it is called a labial hernia. A boy or man at any age 
may have a hernia in the groin, but in the female this rarely occurs 
until puberty, and usually not until middle or advanced life. Al- 
though brought on by severe strain, a hernia is generally due to a 
natural weakness in the walls. When such constriction occurs as 
to prevent the passage of blood and feces in the part protruded, 
the condition is known as strangulated hernia. 

The new-born child that has a hernia at the navel should be 
promptly treated by pressing the protrusion back into the abdo- 
men, then applying to the navel a compress composed of several 
thicknesses of soft cloth, and binding it firmly to its place by a 
bandage, and this should be worn day and night until a cure is 
effected by nature's own methods. In like manner a child having 
hernia in the groin should have the protrusion reduced, a compress 
applied to the hernial site and firmly bound in place by several 
turns of a figure 8 bandage, one turn passing around the body, 
the next around the thigh on the defective side and. coming 
back, be crossed over the hernia, then around the body, and again 
around the thigh, repeating these turns until the protrusion can 
have no chance of escape. This bandage must likewise be worn 
day and night that the hernial opening may be kept constantly 
closed and the parts thereby have a chance to grow together. The 
best material for such a bandage is soft white flannel, cut bias in 
strips about three inches wide and sewed together end to end until 



230 



MINOR SURGERY. 




Bandaging for Groin Hernia in a Child. 



the required length is secured. Several such bandages should be 
provided, as there will need to be changes when they become 
soiled. In doing this the nurse must lay her finger over the 
hernial opening and prevent the protrusion of the gut, until the 
compress and bandage have been reapplied. In babies and chil- 
dren, if care be taken to keep the hernia properly and constantly 
reduced for a year or two, a cure will almost always follow; but 
not so with adults, for in them a cure is the exception, rather than 
the rule. 

In an adult the protrusion should be reduced and held in place 
by a well fitting truss, for when a hernia is out there is always 
danger of its becoming strangulated, and a surgeon meets nothing 
in his practice more serious than a strangulated hernia. To secure 
a perfectly fitting truss the patient should have the aid of his 
physician, and during the fitting should assume all kinds of pos- 
tures, as those of lifting, stretching the limbs, and bending the body 
this way and that, and he should strain in each of these unusual 
positions, through all of which the truss should hold the hernia 
in place. If it does not it should be rejected and another applied, 
and so on until a perfect fit is secured. A truss is not usually 
worn by an adult at night, but is removed after the patient lies 
down, then reapplied before rising. That hernia is much more 
common than most people realize may be seen by a glance at the 



MINOR SURGERY, 



231 



magnitude of the truss business; a single city in the United States 
turns out a half-million hernial trusses annually. 

Strangulated Hernia. — Should one be so unfortunate as to 
have strangulation of a hernia, a physician should be summoned 
immediately and at the same time be informed as to what has 
happened that he may not delay in answering the call. The symp- 
toms are pain and tenderness in the hernia ; the swelling becomes 
harder than usual ; there are colicky pains through the abdomen, 
sometimes extremely severe ; occasionally the patient sweats pro- 
fusely because of the pain, even becoming cold and almost lifeless, 
thus showing that he has entered a very dangerous stage of col- 
lapse. 




Position for a Patient Suffering with Strangulated Hernia. 



Treatment. — A patient with strangulated hernia should be 
made to lie upon his back, with his hips much elevated.- A very 
good way to get this position is to place a chair so that its top and 
the front edge of the seat shall rest upon the bed, the back of the 
chair being pushed under the back of the patient until his hips rest 
on the rear edge of the seat, his legs from the knees falling over 
between the chair legs, its back and rounds having been covered 
with a folded blanket. 

A bag of pounded ice, or some other very cold application, 
should be placed upon the hernial swelling to arrest inflammation, 



232 MINOR SURGERY. 

and in ten or fifteen minutes efforts at reduction of the protrusion 
should be made by the patient, who is likely to be much more skill- 
ful than anyone else in reducing his own hernia. Failing to reduce 
it, he should be kept in the above position that the blood may 
gravitate from the swelling, and the cold applications continued 
until the doctor arrives. Do not apply heat in any form. 

The surgeon usually treats such a case by administering chlo- 
roform, thereby relaxing the tissues surrounding the hernia, then, 
having bent the thigh upward and turned it somewhat inward, by 
gently pressing and kneading with the broad surface of his hands, 
he attempts to reduce the hernia. If this is not successful, it is 
his duty to cut down from the hernia to slightly enlarge the open- 
ing, thus allowing the gut to fall back into its natural position, then 
sew the edges of the wound together. To do this properly is 
usually a complicated procedure. 

To effect a cure by means of a truss it must be so applied as 
to produce great pressure and pain, in fact all the pain that the 
patient is willing to bear, and the process continued for several 
days and nights, or even weeks, thereby exciting an adhesive in- 
flammation which shall result in a growing together of the surfaces 
of the hernial opening. This treatment is much more likely to 
succeed if applied soon after the hernia first appears. In an old 
hernia it is not often of much value. 

RECTAL PROLAPSUS AND PROCIDENTIA. 

Prolapsus of the rectum is a descent of the lower part of the 
rectum, either partial or complete, the mucous membrane and 
sub-mucous tissue being turned out of the anus. 

Procidentia is the descent of the upper part of the rectum, 
all its coats, through the anus, the upper part of the rectum de- 
scending through the lower part. 

Both these conditions, although most common in children, 
quite often occur in won] en who have borne many children, and 
in men of advanced years. In children it is thought to be caused 
by diarrhea, dysentery, severe coughing, long continued crying, 
and much straining to move the bowels. 

A frequent cause is the bad practice of placing a child upon a 
chamber and leaving it there a long time. 

In adults it may be caused by chronic diarrhea, dysentery, 
severe cathartics, long continued use of injections, strictures of the 
urethra, severe straining, internal piles, polypi, tumors, etc. 



MINOR SURGERY. 233 

Treatment. — In children a speedy cure can generally be ob- 
tained by removing the cause, but when no source of irritation can 
be found the general health must be improved. The child must 
not be allowed to sit and strain at stool, but all movements of its 
bowels should be made while lying upon its side near the edge of 
the bed, or while in a standing position, and one buttock should 
be drawn aside to tighten the anal orifice while the feces are pass- 
ing. After the movement the protruding parts should be well 
bathed by dashing cold water upon them with the hand, then 
thoroughly treated with a solution of alum or oak bark, or weak 
carbolic acid, applied with a soft cloth or sponge. The bowel 
must then be gently pressed back through the anus to its natural 
position, and the child should for some time continue lying upon 
its stomach. As a rule cathartics should not be given, but where 
there is intestinal irritation from three to five grains of cascara 
sagrada may be administered morning and evening. 

Hard feces should be softened by mild injections before they 
are passed, and a repetition of the condition avoided by a diet of 
gruels, graham mush, and other laxative foods. Only nutritious, 
easily digestible articles should be eaten by one suffering from this 
trouble. 

The more serious cases usually require surgical treatment, 
which may include the use of acids, hot instruments and the knife. 



GENERAL DISEASES. 
CHAPTER I. 

By R. E. McVey, M.D. 



DIGESTION. 

The alimentary canal is the great duct by which the foods are 
conveyed through the body and their useless parts evacuated, and 
consists of the esophagus or gullet, the stomach, and the small and 
large intestines. The stomach is the most dilated of these four 
parts, and besides serving as a reservoir for food, is the principal 
organ of digestion — the mill which completes the w r ork begun by 
the teeth. The esophagus opens into it near its larger or 
cardiac end, and the duodenum — the upper portion of the 

small intestine — begins 
at its smaller or pyloric 
end. It is composed of 
four coats or mem- 
branes — the external or 
peritoneal, the muscu- 
lar, the sub-mucous and 
the mucous, and be- 
tween them are distrib- 
uted the blood vessels, 
lymphatics and nerves. 
It is now known to have 
no villi like those of the 
intestine for absorbing 
nutrients. 

The size of the 
stomach varies in differ- 
ent persons, and in the 
same person at different 
times according to the 
degree of its distention, 
lative size of the stomach. but when moderately 

235 




236 GENERAL DISEASES. 

filled its average length is about twelve inches and its vertical 
diameter about four inches. It has two movements : A kind of 
rotary or churning movement whereby the food is mixed with 
the gastric juice and triturated or broken up into very fine parts, 
and a peristaltic movement which, as fast as the food is dissolved 
or reduced to a semi-fluid state called chyme, presses it along 
and out through the pylorus. 

Digestion is the process of dissolving food until, in fluid form, 
it can pass through the membranes of the digestive canal into the 
blood. This is accomplished by means of mechanical and chemi- 
cal processes. The mechanical parts are mastication and the 
muscular action of the stomach whereby it grinds or disintegrates 
the food. The chemical part is performed by the aid of ferments. 
A "ferment" is a substance which works changes in other sub- 
stances and to some extent alters their chemical composition; 
thus yeast is a ferment used in bread-making. Saliva is a diges- 
tive ferment, gastric juice is another, and pancreatic secretion a 
third. As derangement of any of these may cause digestive dis- 
turbances, it is desirable to know something of the function of 
each. 

Mastication consists not only of carefully chewing the food, 
but also of thoroughly mixing it with saliva and atmospheric air. 
The saliva is an alkaline ferment and its action upon the starchy 
parts of the food is the beginning of digestion. It continues until 
the food has entered the stomach and, by its presence there, excited 
glands that pour upon it a thin fluid known as gastric juice. This 
is an acid ferment, and as starch can be digested only in an alkaline 
solution, the gastric juice stops the digestion of the starchy 
materials, but through its affinity for albumen, immediately com- 
mences to act upon the albuminoids — those parts of the food 
containing albumen. 

The muscular action of the stomach now begins and, rolling 
the food over and over, works and rubs it until the two forces, 
chemical and mechanical, have reduced the entire mass to a half 
fluid condition called chyme ; a task generally requiring from 
two to four hours. The duodenum, into which the food next 
passes, is the seat of the most active digestive processes occurring 
in the whole system. Here the liquefied albuminoids are ab- 
sorbed by a network of microscopic veins lying within the walls of 
the intestine; and here the chyme is mixed with the bile and the 



GEXERAL DISEASES. 237 

pancreatic secretion. The latter is the most powerful of all 
digestive ferments, and the most complex in composition. It 
contains diastase to digest the remaining starchy food, trypsine 
to dissolve the remaining albuminoids, a ferment to act upon milk, 
and one to act upon the fats and, with the help of the bile, change 
them into an emulsion, that is break them up into exceedingly 
minute particles, that they too can be absorbed. 

The nutrients derived from the starchy and albuminoid ma- 
terials are absorbed by myriads of microscopic veins and borne 
along with the blood to the great portal vein, to be carried to the 
liver for purification ; while the fats are absorbed by another sys- 
tem of vessels called lacteals, borne to the thoracic duct and thence 
thrown into the blood. 

INDIGESTION. 

The brief outline just given may serve to show that so many 
parts compose the digestive process as to make the term "indiges- 
tion," as commonly used, a very indefinite one, far too indefinite 
to be of much value in the diagnosis of disease ; that the very part 
of the work that is being improperly, or not at all, performed must 
be pointed out before a remedy can be chosen ; and therefore that 
the use of any nostrum or cure-all, though patented, sold ready 
made and cheap, is much more liable to do harm than good, and 
that because pepsin has relieved one man's stomach ache it is not 
sure, or even likely, to help yours. 

Diagnosis. — To locate any digestive trouble begin at the 
beginning and examine the teeth to learn whether they are in con- 
dition to properly chew the food. If not, secure the services of a 
good dentist. This matter should have much more attention than 
it usually receives. Through lack of care in early life, people are 
often left without teeth just when they need them most. Al- 
though no substitute can make good the loss, artificial teeth, as 
perfect as possible, should be promptly obtained. 

Salivation should next receive attention. How do you eat? 
If it is your habit to eat hurriedly and bolt the food, not taking time 
to chew it well, and properly mix it with air and saliva, or if you 
wash it down with large amounts of drink, especially iced drink, 
a halt should be called. That it may perform its part of digestion 
by changing cane sugar and starch into glucose, or grape sugar, 
the form in which their nutrients are taken into the blood, the 



238 GENERAL DISEASES. 

saliva must be undiluted and thoroughly mixed with the food. 
Refrain from drinking much at meals, since it not only interferes 
with digestion and impairs the health but, what seems of even 
more importance to many, is the chief cause, by stomach and 
bowel distention, of the big, unsightly abdomens so common 
in middle and later life. Would you long enjoy perfect health, 
take your food slowly and chew it well. Even a glass of milk 
is better for being taken slowly, for, as curdling is the first step in 
its digestion, if it be taken a little at a time, the formation of many 
small curds instead of one large one makes the remaining parts of 
the process natural and easy. 

The muscular action of the stomach may be so impaired 
as to render it unable to disintegrate the food, and indigestion fol- 
low. This may result from a diseased condition of the muscular 
coat, or from ulcer or cancer. Disease of the muscular coat is 
usually some form of gastric catarrh, often, but not always, accom- 
panied by catarrh of the nose and throat. Gastric catarrh in its 
chronic form is known by many as chronic dyspepsia. In this 
stage pain amounting to a burning soreness is felt back of the 
breast bone and is sometimes increased by taking food. There is 
often tenderness, nausea, some retching, furred tongue with con- 
stipation, sometimes diarrhea, belching, dilatation, regurgitation, 
acidity of the stomach, foul taste in the mouth, heartburn, sore 
mouth, headache, dizziness, drowsiness but sometimes sleepless- 
ness, nervousness, mental confusion and sometimes insanity. 

In all of these cases the chief remedy is a modified diet. The 
food must be so prepared and of such kinds as not to require dis- 
integration. In the milder forms of the disease it may be suffi- 
cient to avoid such food as has been found to disagree with the 
patient, and all foods not easily disintegrated, such as pork, veal, 
pastries, etc., but in severe cases a very strict diet must be enforced, 
and all the food be in fluid or semi-fluid form, as milk, milk-gruel, 
beef juice, beef tea, mutton broth, or some similar preparation, to 
most of which some baked flour can often be added with advan- 
tage. In this disease the effectiveness of the muscular action of 
the stomach is often greatly diminished by the presence of an 
excessive amount of mucus that binds the food together in a 
tenacious mass about which, as the mass rolls over and over, it 
forms an insoluble coat so that the action of the gastric juice is also 
very much impeded, and little digestion of any kind can be effected 
until the materials finally pass from the stomach into the intestine. 



GENERAL DISEASES. 239 

Treatment. — The stomach should first be thoroughly washed 
out. This may be done by taking five to ten grains of ipecac in a 
half tumbler of warm water. If free vomiting does not follow, 
assist by tickling the throat. The work is done in a much more 
thorough and better way by means of a stomach tube and salt and 
water, a teaspoonful to the quart. The best time for doing this 
is at bed time or four to six hours after eating, and the temperature 
of the water should be as nearly that of the body as possible. The 
stomach tube is made of very soft flexible rubber, is about a half 
inch in diameter and expands at the upper end to form a funnel. 
When the lower end has been placed well back in the patient's 
throat he swallows it ; when some fourteen inches of the tube have 
thus been taken, the assistant pours about a pint of water into the 
stomach, then, as he lowers his end, the tube becomes a syphon, 
or the patient by straining or coughing a little expels the water 
through the tube and with it the mucus and whatever else is 
there. Repeat the process until the water drawn out is clear. It 
is not difficult to swallow the tube after the first time and its use 
not only immediately relieves the patient of a very injurious and 
loathsome mass, and cleanses the stomach thoroughly, but it 
reveals, better than any other method, the exact condition of the 
stomach itself. The use of the tube should be continued every 
other day as long as such relief is required, and an hour later give 
ten grains of papoid to check the formation of more mucus. 
Powdered charcoal is also an excellent remedy. 

To restore activity to the muscular walls, after the washing 
out use the following: Nux vomica ten grains; phosphide of 
zinc three grains; mix. make into thirty pills and take one im- 
mediately after each meal. This remedy should be taken only 
upon a full stomach. In this, as in all cases of inefficient stomach 
disintegration, diet is the main remedy; but remember that too 
often a "course of dieting" is made a course of starving. Diet in 
this connection does not mean a rigid cutting down of the food 
supply, but a very careful selection of the kinds of food. 

The body needs to be thoroughly nourished at this time and 
care must be used not only to take the right food in the right form 
at the right time, but to take enough of it to keep the nutrition 
fully up to, or above, what it has been, always guarding, however, 
against overeating. It is of great importance to take the meals 
at regular hours and to eat nothing at all between meals. 



240 GENERAL DISEASES. 

Ulcer and Cancer are both indicated by pain in the stomach, 
aggravated upon taking food, and it is not always easy to diagnose 
between them. Cancer is most common in the male sex above 
the age of forty and is usually found in the pyloric or lower end 
of the stomach. If there be an increase of pain immediately after 
taking food it is probably due to an ulcer in the upper end, but if 
the increase comes later a lesion in the lower end is indicated and, 
if it be a cancer, it can usually be felt with the hand as a hard lump 
or tumor in the stomach just below the ends of the right ribs. The 
appetite is often abnormal with cancer and the patient craves 
things that in health he would loathe, but with ulcer this is not 
the case. With ulcer the pain is generally relieved by vomiting, 
but with cancer it is not. As long as the stomach is at rest there is 
likely to be no pain with ulcer, but with cancer there may be pain 
at any time, and, as the disease progresses, the pain becomes con- 
tinuous. In either case, or for any irritation of the mucous coat, 
twenty grains of subnitrate of bismuth in a tablespoonful of water 
should be taken just before each meal to form a coating over the 
affected parts and prevent irritation and pain. The same diet 
must be used as in cases of gastric catarrh. 

CONSTIPATION. 

Constipation is an unnatural retention of fecal matter in the 
bowels, and is a most common disorder. It is almost always 
present in dyspepsia, precedes and accompanies most other dis- 
eases, and often follows them. Its causes are many, but chief 
among them are too much sitting and too little outdoor air and ex- 
ercise, too rich food, the use of opiates, and of tea, coffee, tobacco 
and other stimulants, inactivity of the muscular coat of the intes- 
tines, intestinal catarrh, intestinal strictures, taking medicines for 
every slight ailment, too frequent use of injections and neglect to 
heed the calls of nature ; the last named being a very frequent 
cause. The health very largely depends upon regularity of the 
bowels. 

The seat of the trouble is the large intestine. This organ 
is so called because of its size. It is about five feet in length ; its 
upper, middle and lower portions being the cecum, colon and 
rectum. The contents of the bowels are gradually carried down 
into the rectum, where their presence excites a desire to discharge 
them ; but if not gratified this desire soon ceases, for the peristaltic 



GENERAL DISEASES. Ul 

action of the intestine presses the feces up into the colon again ; 
in which case their liquids are absorbed and their poisonous im- 
purities taken into the blood, often causing great derangement 
and very serious disorders. 

The liver in its efforts to throw out the poison becomes over- 
worked and disabled, and is often wrongly blamed as the cause 
of the trouble, although at the same time the blood may be so 
charged with fecal matter as to badly contaminate the breath of 
the patient. The kidneys may become clogged with the excess of 
impurities, the circulation of the blood be impaired, resulting in 
cold feet and limbs, and the stomach, pancreas, spleen, heart and 
brain all partake of the general disorder. 

There is great difference in the frequency with which healthy 
people have action of the bowels. Some move them more than 
once a day ; others only once in two or more days ; but when the 
usual number is not maintained, and at the same time there is dis- 
comfort, a condition is indicated which calls for treatment. Xo 
one who is irregular in this respect can long enjoy good health. 

Symptoms. — Infrequent movement of the bowels; hard, 
lumpy feces, voided with difficulty ; inactive liver ; foul breath : 
bad taste in the mouth in the morning; variable appetite; trans- 
parent urine ; sallow complexion ; headache ; mental depression ; 
palpitation of the heart ; piles ; cold feet and a tendency to take 
cold upon the slightest exposure. 

Treatment . — As much as possible remove all the causes. If 
the patient has been much confined within doors he should take 
abundant outdoor exercise, of which, for most people, horseback 
riding is the best. A change to an outdoor occupation is an ex- 
cellent way of restoring this function. The bowels should be 
moved every day, and the best time for this is just after breakfast. 
Always obey nature's call immediately. If there has been no move- 
ment, take a little gentle exercise and half an hour after breakfast 
sit down in the privy and wait fifteen minutes, making frequent 
efforts. 

Vigorously kneeding and striking the bowels with the hands 
for five minutes or more several times each day is often a great 
help. The diet must be such as to assist in this work. If the 
stomach will tolerate it the food should consist of coarsely-cracked 
boiled wheat, preparations from graham, Ralston flour and un- 
bolted meal, and fruit, either fresh or dried. Fresh fruit is best, 

16 



242 GENERAL DISEASES. 

The meals should always be taken at regular hours and all piecing 
or eating between meals prohibited. It is unwise to drink much 
during meals, but water should be taken freely an hour and a halt 
or two hours later. Drinking a glass of water before breakfast has 
been known to do the work ; if found to be ineffectual it should be 
discontinued. 

Injections are often a help, and their efficiency may be in- 
creased by adding a little salt or soap, but the more injections are 
used the more the need for them increases, until the bowels will not 
move at all without them. They should, however, be used before 
a movement when the feces have formed into large lumps and be- 
come dry and hard. Applications of electricity, also of heat, to 
the abdomen are recommended. By patience and a thorough per- 
sistence in the use of the above simple means the most obstinate 
cases may be overcome. It is better not to use many drugs, for, as 
already seen, drugs frequently cause the disease, but where there 
are insufficient fluids and diminished peristaltic action, from five 
to ten drops of the tincture of mix vomica in a glass of water three 
times a day is a most valuable remedy, correcting the constipation 
without the debilitating and other bad effects produced by most 
cathartics. By acquiring habits of regularity in early life, then 
persisting in them, most cases of constipation can be avoided. 

DIARRHEA. 

Diarrhea is a morbidly frequent evacuation of the bowels, the 
stools being more or less fluid in character. It is called acute or 
chronic accordingly as it is of short or long duration. As a rule 
affections of the large intestine give rise to dysentery and those of 
the small one to diarrhea. At least three conditions may occur in 
the small intestine, any one of which may cause diarrhea. They 
are an increase in its peristaltic movements, an increase in its secre- 
tions, and a diseased condition of its mucous membrane. Two 
or all of these conditions are often present at the same time. 
In diarrhea there is very little if any blood and, next to watery 
serum, mucus is the most common and constant admixture 
with the feces, and when present of course indicates a morbid 
condition of the mucous membrane. Although the discharges are 
always more or less fluid their character changes with the progress 
of the disease; and they may range in color from a light yellow 
to a dark brown ; in infants they are often green, and in adults are 
sometimes so fluid and pale as to look almost like rice water. 



GEXERAL DISEASES. 243 

ACUTE DIARRHEA. 

The exciting cause is often very definite. Mental excitement, 
exposure to cold, irritating foods or medicines, food but partially 
cooked, food that has commenced to decompose, chunks of meat, 
green or over-ripe fruit, some kinds of plums, raw vegetables, as 
cabbage, celery, radishes and cucumbers, raw dried fruit and im- 
pure drinking water, especially that containing animal or excre- 
mentitious matter, may any of them cause diarrhea. It may also 
be caused by water impregnated with sewer gas, such as usually 
found in cisterns with overflows opening into the sewer. 

It is a very fatal disease in infancy and is most frequent among 
those living amid bad surroundings, the poorly nourished, and those 
suffering front or predisposed to other diseases. It is most com- 
mon in infants from six to eighteen months of age and its ravages, 
in the north temperate zone, are greatest in July. Among its 
causes in infants the following are prominent : 

i. Improper food. In the very young, food containing 
starch will provoke it, because infants until about six months old 
cannot digest starch. They should not be fed anything but milk. 
If the mother's milk be not sufficient, cows' milk should be the 
only substitute, and, as bacteria cause a large proportion of the 
diarrheal disorders in artiiically fed children, care should be taken 
to get milk that is as fresh and pure as possible and, in every case, 
to properly sterilize and modify it before feeding. 

2. Irregularity in feeding. 

3. Exposure to cold. Very young children must be pro- 
tected against sudden changes of temperature, and, if predisposed 
to diarrhea, must, while in health as well as while suffering from 
an attack of the disease, wear soft flannel next the skin. 

4. Weaning in hot weather. Except in cases of emergency, 
a child should never be weaned during hot weather. 

5. Increase in atmospheric heat. The prevalence of the 
disease increases as summer advances until mid-summer is reached, 
after which it usually gradually subsides. Although very com- 
mon in warm weather among children cutting teeth, it is by no 
means a necessary accompaniment of dentition, and then, as at all 
other times, thorough means should be used to effect a cure. 

Diarrhea of mild form may be attended by very little disturb- 
ance of the general health in adults, though to the aged and those in 
middle life who have been weakened by other diseases it may some- 



244 GENERAL DISEASES. 

times prove fatal, but to infants it is a very dangerous disease, a 
slight diarrhea often causing great loss of vital power, as indicated 
by coldness of the extremities, dark color and sinking in of the 
spaces around the eyes, and depression of the fontanels (spaces be- 
tween the skull bones) ; the last being a most valuable sign, since 
it may give warning of clanger at an early stage of the disease, 
when otherwise there may seem to be little if any cause for 
alarm. 

Epidemics of diarrhea are thought to be due usually to a com- 
mon cause rather than to contagion or infection, but, as some 
forms of the disease are caused by germs, it is a wise precaution 
to carefully disinfect the discharges and all clothes soiled by the 
patient and, as much as possible, to avoid exposure to the disease. 
Unless prolonged by continued use of bad water or bad food, or 
by bad surroundings, acute diarrhea runs its course in a period 
varying from a few hours to a week or ten days. 

Symptoms. — The following are symptoms, though they may 
not ah be present in one case : Looseness of the bowels or purging; 
pain in the abdomen ; nausea ; vomiting ; foul breath ; headache ; 
gas ; faintuess ; dizziness and a sense of great weakness. Children 
more often than adults have fever with diarrhea, but more fre- 
quently the surface, especially of the hands, feet and limbs, is cold. 

Treatment for Adults. — In an adult it is not best to im- 
mediately check a diarrhea of mild form lest the patient be 
thrown into some more serious disorder ; but if the attack be of any 
Severity he should seek absolute rest in bed : and heat should be 
applied to the abdomen, or a mustard poultice used instead, or a 
layer of batting be spread over the abdomen and covered by oil- 
linen to retain the animal heat, and care must be taken to keep 
the feet and limbs warm. First give from one to two tablespoon- 
fuls of castor oil to clear the stomach and intestines of all irritating 
substances. If preferred, the patient may take rhubarb instead, 
but it is not as good a remedy. Ten hours later he should take 
from fifteen to forty-five grains of subnitrate of bismuth, and repeat 
the dose after each movement. 

Great benefit is often derived from an injection. It should 
consist of a quart of water that has been well boiled, then cooled 
to the point of endurance, thrown into the rectum with a syringe 
and retained as long as possible. The hotter it can be taken with- 
out burning the more it will relieve pain. Cloths wrung from ice 
water and applied to the rectum are an aid. 



GENERAL DISEASES. 245 

Although prescriptions containing a large number of in- 
gredients are not as highly favored now as formerly, the follow- 
ing has given such excellent results, and can be so easily kept on 
hand for a household remedy, we recommend it : 

Laudanum two drams 

Spirits of camphor two drams 

Tincture of rhubarb two drams 

Tincture of myrrh two drams 

Tincture of Cayenne pepper one dram 

Give from five to thirty drops after each movement until the 
bowels are controlled. This sometimes succeeds where bismuth 
fails. 

The patient will often be greatly helped by an abdominal 
bandage. It should be a strong soft cloth about a foot wide 
pinned snugly around the body. Soft flannel underclothing 
should be worn during the attack and until full recovery ; by those 
predisposed to the disease it should be worn all the time. 

The diet should consist of beaten eggs cooked in water, boiled 
milk, either pure or diluted with lime water, boiled rice and milk, 
broths, beef tea and other bland articles. Until full recovery the 
patient must refrain from meat and all rich and irritating food. 

Treatment of Infants. — Although in adults it is not best to 
check a diarrhea immediately, in children it should be arrested at 
the very beginning, or as soon thereafter as possible, for with them 
it often does its work quickly. First give castor oil, a teaspoon- 
ful to a child of from three to six months, and proportionally more 
to those that are older, and in five or six hours give from five to 
ten drops of paregoric, or from five to ten grains of subnitrate of 
bismuth, after each movement. It should take very little food 
for twenty-four hours, after which its diet should be breast milk, 
thin broth, or fresh milk that has been properly sterilized and 
modified, and to which a little lime water has been added. 

To guard against another attack the careful feeding should 
continue five or ten days after recovery. Until quite well the 
child must be kept very quiet in bed, for running about at this 
time is very injurious. 



CHRONIC DIARRHEA 

: generally given to a 
than fifteen days ; it is. however, a very different form from acute 



This is the name generally given to a diarrhea lasting more 



246 GENERAL DISEASES. 

diarrhea, and may last months or even many years. The intes- 
tines may then present appearances thought to be due to chronic 
catarrhal inflammation, but in many cases examinations made 
after death have failed to disclose any change at all in the intes- 
tines, although the patient had suffered a very long time from 
this disease. Bad surroundings, old age, an enfeebled constitu- 
tion, chronic disorders of digestion, all are predisposing causes. 
It is so uniformly present in tuberculosis, typhoid fever and 
syphilis as to constitute prominent symptoms of those diseases. 

In addition to what has been said, an extended description 
is not needed to enable anyone to recognize a case of chronic 
diarrhea, but it may arise from so many different causes, or com- 
plications, as to baffle the most skillful physician in his efforts 
to prescribe a cure. In general it may be said that the same 
remedies and diet should be used in this as in the acute form, 
but they must be used a long time steadily and with great per- 
sistence. Astringents are often valuable here, although they 
should not be used for the acute form. 

As long-continued diarrhea steadily saps the strength, means 
must be used to keep up the vitality. For this purpose beef juice 
is excellent, for by its use the patient obtains the nutrients of 
the beef without incurring the risk of injury from its coarse and 
irritating fibers. It is prepared by cooking good steak just enough 
to heat it through, then, while hot, extracting its juice with a 
press or lemon squeezer, and salting to the taste. The white 
of an egg, whipped into foam and eaten with boiled miik, is also 
recommended. To increase its richness a teaspoonful of sugar of 
milk (not cane sugar) should be added to each tumblerful of the 
milk. 

Slices of white bread, kept in a moderately hot oven until 
brown and crisp clear through, eaten with boiled milk, is a very 
valuable food at this time. In both of these dishes a little lime 
water should be added to the milk to aid in its digestion. Both 
are better eaten hot. 

DYSENTERY. 

Dysentery is an inflammation of the rectum or colon, attended 
with griping pains, constant desire to evacuate the bowels, and 
discharges of mucus and blood. There is likely to be chilliness 
followed by high temperature, ulceration of the intestine and 



GEXERAL DISEASES. 247 

burning pain in the rectum. In the epidemic form the disease 
is infectious, being due to germs, and to prevent its spread great 
care should be taken to disinfect the discharges, and all articles 
used about the patient as soon as removed from him, and only the 
nurse should be admitted to his room. 

Treatment . — To cleanse out the intestine the patient should 
take a tablespoonful of Epsom salts in a glass of hot water, and 
each evening at bedtime be given an injection made up as follows: 

Laudanum fifteen drops 

Quinine twenty grains 

Subnitrate of bismuth forty grains 

Water four to six ounces 

which should be held in the rectum as long as possible. 

Although he may feel able to be up, the patient should re- 
main quiet in bed, and should be kept warm, especially his feet 
and limbs. Sponge the body with water and vinegar or alcohol 
to cool the burning skin, and wash the anal region often with a 
disinfectant, such as a solution of boric acid, after which anoint 
the rectum with vaseline. Cold applications, such as recom- 
mended for diarrhea, may also be made to the rectum. To relieve 
pain in the bowels apply heat to the abdomen. The diet should 
be restricted to a small amount and should consist of such articles 
as named in the treatment for diarrhea. There should be no 
cold food taken, and tea, coffee and tobacco should be let alone. 
If properly treated the patient will soon be well, but to prevent 
a recurrence he should guard against exposure, improper food 
and overexertion for some weeks. 

Obstinate cases of chronic dysentery are thoroughly cured 
only by a sea voyage, a sojourn at the seashore or in the moun- 
tains, or some other change of climate and surroundings. 

CHOLERA MORBUS. 

Cholera morbus is thought by some to be a form of acute 
gastric catarrh which extends to the mucous membrane lining 
the intestines, but it is quite as likely that it is often a result of 
nervous exhaustion. It most often occurs in hot countries but is 
common throughout the temperate zones, and is most frequent 
there during the middle and latter parts of summer when the 
days are hot and the nights are cool. It is found also among 
adults, but is most frequent in youths and children. 



248 GENERAL DISEASES. 

In hot weather persons of very nervous tendencies, those 
undergoing severe nervous strain, and those much reduced by 
great bodily fatigue are the most liable to the disease, a fact that 
has led to the belief that because of exhaustion of the motor nerves 
of the stomach the digestive processes are impaired and food, 
remaining longer than it ought in the stomach, gives rise to 
poisonous fermentative products, irritating to the sensory nerves 
and exciting more and more disturbance. 

It is so called from the close resemblance of many of its symp- 
toms to those of Asiatic cholera, but the two are very different 
diseases. Cholera morbus is characterized by very severe ab- 
dominal pain centering near the navel, nausea, violent and frequent 
vomiting, purging of watery stools, very painful contraction of the 
muscles, especially of those of the calf of the leg and the ex- 
tremities. The countenance has a pinched, sunken appearance and 
is of a pale or bluish cast ; the pulse becomes weak and very rapid; 
breathing is difficult ; the mouth and tongue are dry and there is 
great thirst. The surface of the body has a shriveled look and is 
cold, but the internal temperature may range from 99 degrees to 
102 degrees. Because of the transudation of serum into the 
stomach and intestines the blood constantly becomes thicker and 
the secretions, especially the urine, are greatly diminished, if not 
entirely stopped. 

The attack often comes in the night and usually is very sud- 
den. The food last eaten is first vomited and appears but little 
changed, but as vomiting is repeated there are large quantities of 
pale yellow or greenish fluid thrown out with great force; there 
is rumbling or gurgling of air in the intestines ; the stools be- 
come thin and fluid, and the greater their quantity the less their 
color until they assume a rice-water appearance ; the voice be- 
comes faint, the patient weakens rapidly and there are signs of 
a general collapse. But no matter how bad the symptoms or how 
great the depression of the patient, a previously healthy adult al- 
most always recovers in a few hours, though an attack may last 
three days. Usually the vomiting and purging gradually grow 
less frequent and the exhausted patient falls asleep to awake 
in a few hours greatly restored. 

Treatment. — The treatment must be adapted to each case. 
If begun before sufficient vomiting has occurred to clear the 
stomach of all undigested food, emetics of hot water and mustard 



GENERAL DISEASES. 249 

flour or common salt should be given and repeated until the 
stomach is thoroughly emptied ; but if there be frequent vomiting 
of green watery material containing no undigested food, and there 
be much purging, pain, cramps and great weakness, a hypodermic 
injection, consisting of one-eighth of a grain of morphia and one- 
two hundredth of a grain of atropia, is the best remedy, and if 
the patient is not greatly relieved another should be given in two 
hours, care being taken in every case to first thoroughly disinfect 
the syringe by placing it in alcohol or boiling water. It is better 
not to give brandy or any other stimulants, in connection with the 
morphia. To patients who object to hypodermics a tenth of a 
grain of calomel should be given every half-hour until ten doses 
have been taken, and with every other dose one-twentieth of a 
grain of morphia should be given by the mouth. The extremities 
should be warmed by free friction and applications of heat, as hot 
water bottles and the like. In case the vomited material be 
strongly acid, bicarbonate of soda and subnitrate of bismuth, five 
grains of each, may be given. Unless the vomiting is excessive 
it is better not to try to check it. In mild cases children may 
require no other medicine than a dose of castor oil, but calomel, 
in one-tenth-grain doses every hour until eight or ten have been 
taken is a better remedy. Bits of ice are good to quench thirst, 
but ice-cold ginger ale, a half glass at once, is excellent, and, 
if the ale cannot be obtained, hot ginger tea is good to restore tone 
to the stomach. As this organ needs absolute rest no food should 
be given for a long time, and then the diet should be very light 
and consist of easily digested and nutritious food. 

Cholera morbus very rarely proves fatal except in weak or 
aged people, or in children ; to the latter, especially, it is a danger- 
ous disease. To guard against a second attack indulge but spar- 
ingly in iced drinks, avoid exposure to night air, dampness and 
sudden changes of temperature, protect the body with plenty of 
blankets at night, discard all green or over-ripe fruits and foods 
liable to fermentation, and attend promptly to attacks of indiges- 
tion and all irregularities of the bowels. 

COLIC. 

Colic, from a Greek word which signifies pertaining to the 
colon, is a term that, properly used, applies only to such affections 
as are attended with severe pain in the abdomen and with spas- 



250 GENERAL DISEASES. 

modic contractions of the muscular walls of the intestines, but 
many of the symptoms are so similar to those of neuralgia of the 
intestines (enteralgia) that the name is also often applied to the 
latter disease; hence, to be explicit, some writers designate the 
former as intestinal colic. Its causes are numerous, but the prin- 
cipal ones are direct irritation of the bowels by green fruit, stale 
or decaying vegetables, or other improper or undigested food, acrid 
or poisonous substances, ices, cold drinks, excessive secretion of 
bile, retained feces, as when associated with constipation, gas, for- 
eign bodies, as fruit-stones or worms, various forms of intestinal 
obstruction, the morbid conditions of the blood sometimes at- 
tending gout and rheumatism, taking cold, lead poisoning, dis- 
orders of the nervous system, strong emotion, etc. Similar symp- 
toms may be caused by reflex irritation, as in ovarian and uterine 
affections, and by the passage of kidney stones or gall stones. 

Symptoms. — Attacks of severe pain in the abdomen, often 
very sudden and intermittent, usually most severe about the navel 
but sometimes spreading over the whole abdomen and liable to 
change from one place to another; sometimes so intense as to be- 
come excruciating agony, known as twisting, tearing or griping 
pain. Pressure almost always gives relief, the patient bending over 
something, as the back of a chair, or pressing the abdomen with 
his hands, or lying upon his stomach. The bowels are usually con- 
stipated and distended with gas, but sometimes there is diar- 
rhea. The spasmodic movements of the bowels and their motions 
from the rolling about of the gas can sometimes be seen, felt and 
heard. The abdominal muscles are often knotted or rigidly con- 
tracted. There is no fever. Vomiting may occur, but in that 
case the difficulty is likely to be in the stomach. The attack may 
finally end as abruptly as it came, and be followed by great relief 
and comfort, but on the other hand it may last so long and be so 
severe as to threaten collapse. 

Treatment. — The first thing to do is to stop pain and spasm, 
then find and remove the cause if possible. An injection of 
water as hot as can be borne, to which has been added twenty 
drops of turpentine or two teaspoonfuls of tincture of assafetida, 
is generally useful if there is much gas, or a brisk purgative may be 
given by the mouth. In children, especially, the large intestine 
may often be relieved of gas by gently inserting through the anus 
a long flexible tube, the patient lying face downward with his 



GEXERAL DISEASES. 251 

shoulders lower than his hips. In less urgent cases a full dose of 
castor oil is recommended, and this is often best preceded by one- 
tenth of a grain of calomel every hour until one grain has been 
taken. Hot drinks, as peppermint, anise, or wintergreen tea, may 
afford relief in the milder cases. The patient should be covered 
warmly in bed and applications of heat, as hot water bottles, hot 
sand bags, or hot fomentations, be applied to the abdomen and 
renewed as often as they cool. Gentle friction is also an aid. 

A little whisky and hot water is often a good remedy. If 
an opiate is given, paregoric is the best; dose from ten to forty 
drops. For severe cases a hypodermic injection of morphia 
is the best remedy to give quick relief, but a few cannot take 
this drug and there are very serious objections to using it at all. 
One-third of a grain of morphine paralyzes the peristaltic action 
of the intestines for ten or twelve hours, and, without removing 
the cause, so quiets or deadens the pain and tenderness in the 
bowels as to make it impossible in many cases to distinguish 
the comparatively harmless forms of colic from those caused by 
intestinal obstruction, the early relief of which by surgical means 
is often necessary to save life. For this reason many of the 
best physicians no longer use morphine in treating this disease. 

Chloroform or ether by inhalation, or by the mouth, is excel- 
lent, but these remedies should be used sparingly, with great 
care, and under the direction of a physician. Use stimulants to 
combat threatened collapse. The patient may be greatly pros- 
trated at the end of the attack, but gets well. Careful attention 
to diet and general hygiene should then be exercised to guard 
against other attacks. 

For enteralgia a gentle galvanic current is often the best 
remedy. See "Neuralgia." For the lead poisoning cases see the 
chapter on "Poisons." 

INTESTINAL OBSTRUCTION. 

Intestinal obstruction may be caused by intussusception, 
which is a drawing or telescoping of the intestine into itself, as 
a part of the finger of a glove may be drawn into another part ; 
by contraction of the diameter of the intestine; by a twisting 
of the intestine upon itself; by an entanglement of the intestine 
known as strangulation ; by compression, as from tumors or other 
morbid growths, or from uterine displacement ; and by impac- 



252 GENERAL DISEASES. 

tion of hardened feces in the lower end of the large bowel. The 
latter condition may be relieved by carefully removing the feces 
with the handle of a spoon or similar instrument, or better, 
by inserting the finger into the rectum and with it breaking up 
the feces, introducing water during the process as may seem 
advantageous ; then, as soon as a way is opened for it, adminis- 
tering a large injection of soap and water and repeating as often 
as necessary to thoroughly empty the bowel. As the other 
forms of intestinal obstruction are usually serious and demand 
early attention, and are likely to need very skillful treatment, 
they should be promptly placed under the care of the best 
physician. Irreparable injury might be done by giving a severe 
purgative, or by waiting too long before applying the right rem- 
edy. They are too serious for domestic treatment. 

Symptoms. — The symptoms of obstruction are extreme pain 
in the intestines, persistent vomiting, vomiting fecal matter, im- 
peded respiration, anxious expression, cold sweat upon the fore- 
head, bowels enlarged with gas, constipation, great prostration, 
and, in bad cases, persistent hiccough. 



SEA-SICKNESS. 

Sea-sickness is generally defined as a nervous affection, 
attended with nausea and vomiting, produced by the motions 
of a ship at sea, ibut it is identically the same condition as that some 
times caused on land by such unusual motions as riding backward, 
going swiftly up and down in an elevator, swinging, turning rap- 
idly, etc. The experiences at sea are more serious since their 
cause is more prolonged. 

The real nature of sea-sickness has never been explained. 
Some persons have it every time they take a voyage, others have 
it but once, a few never have it at all, and it comes in calm weather 
on a smooth sea to a few who are not affected in the strongest 
gales. It may last but a few hours, or may cling to one as long 
as the voyage lasts, but it almost always ceases as soon as the 
patient lands. In many cases it leaves its victims in much better 
health than they had before it attacked them, especially such 
of them as were affected with disorders of the liver or digestive 
organs, melancholia, or intermittent fevers. To those suffering 
with organic stomach, heart, lung or brain disease, and to pregnant 



GENERAL DISEASES. 253 

women, it is dangerous; and such persons should not take sea- 
voyages. 

As preventives, exercise in swings, and taking medicines, are 
of little avail, but eating only light, easily digested food for three 
or four days before going on board is a wise precaution. Many 
sailors recommend wearing a tight girdle. If the voyage is to 
be a short one, sea-sickness may be diminished or escaped entirely 
by taking one's bed as soon as any nausea is experienced, retaining 
the horizontal position for twenty-four hours, keeping a bag of ice 
upon the back of the neck, keeping the eyes closed, and eating very 
little, and that only of the lightest food. Indeed, after a day or two 
of this, many persons find themselves able to go about ship without 
further difficulty. As the smell of bilge, and other foul odors, in 
unventilated parts of the ship, are liable to aggravate the diffi- 
culty, the patient, after this preliminary, is likely to be better off 
when dressed warmly and in the open air. 

Treatment. — To control the nausea and vomiting, wash out 
the stomach with a tube ; keep the bowels regular, by using a 
hot enema if needed ; apply heat to the stomach and ice to the 
spine opposite the stomach ; lie quietly in bed, and quench thirst 
either by holding in the mouth bits of ice or drinking sparingly 
of hot liquids. Things that work well in some cases fail in others. 
Effervescing citrate of magnesia, soda water and lemon juice are all 
good remedies. Sucking an orange will sometimes restore the 
normal tone to a debilitated stomach. When the appetite re- 
turns, eat very moderately and only of light, easily digestible foods. 
Avoid all sweets, alcoholic drinks, fried foods, pastries, and the 

like. 

APPENDICITIS AND TYPHLITIS. 

The vermiform appendix is a small tube or gut attached to 
the back part of the cecum (upper portion of the large in- 
testine). It is about as large as a goose quill, from three to six 
inches long, may be either curved or straight, and at its free end 
comes to a sudden or blunt termination. 

Its purpose was long a puzzle to anatomists, but the best 
authorities now regard it merely as a remnant of the subsidiary 
stomach of the lower form of life from which man has come, 
and that it is of no use whatever to the human organism. In 
many persons it is entirely wanting and from many more it has 
been removed without, in the least, impairing any function of the 



254 GENERAL DISEASES. 

body. In health it is filled with a tough mucus, and for several 
years in childhood is partially closed by a valvular fold of mucous 
membrane at or near its opening into the cecum. 

Inflammation of this appendix is called appendicitis. 

Inflammation of the cecum is called typhlitis. 

Many writers hold that the latter is always an outgrowth 
from the former disease — the inflammation beginning in every 
case in the appendix and spreading from it to the large intestine. 
Be that as it may, the two disorders are so closely related, and 
our space so limited, we will follow the usual custom of con- 
sidering them both under the general head of typhlitis. 

About half the cases of appendicitis are caused by hard sub- 
stances in the appendix, for when they have made an entrance 
it has no means of expelling them. These substances sometimes 
remain in this structure indefinitely without doing any harm, but 
in other cases, sooner or later, lead to inflammation and most 
serious consequences. Such foreign bodies as intestinal worms, 
seeds, pills, bristles, pieces of bone, shot, etc., may be exciting 
causes, but by far the greater number of cases are occasioned 
by small stones, called concretions, formed from fecal matter and 
often closely resembling a cherry stone in appearance. Tuber- 
culosis (consumption) is sometimes the cause, and other germs 
or disease virus may start the inflammation, but in many cases 
it has been impossible to discover any cause. It may occur at any 
time of life, but is most frequent between the ages of twenty 
and thirty years, and more common in the male sex, due, it is 
believed to the female appendix having an additional artery and a 
better blood circulation than has the corresponding structure in 
the male. 

As already explained, the inflammation soon extends to and 
involves the cecum, thus becoming typhlitis. It is sometimes 
impossible to distinguish this disease from a case of mechanical 
obstruction of the bowels; many of its symptoms are like those 
of local peritonitis, and some of them resemble those of typhoid 
fever, so, as a rule, it is only the milder cases that can be satis- 
factorily diagnosed — those in which inflammation has not ex- 
tended beyond the serous covering of the cecum and the adjacent 
parts. 

Symptoms. — Pain, likely to be spasmodic and of great 
severity; tenderness, often so great that the patient cannot bear 



GENERAL DISEASES. 255 

the slightest touch ; nausea, vomiting and constipation, all usually 
very persistent ; loathing of food ; heavily furred tongue and foul 
breath ; a stooping posture and disinclination to either stand 
or walk; a sensation in the right leg as of ants crawling over the 
skin ; hard, quickened pulse ; scant, high colored urine ; often the 
first symptom is a chill, closely followed by acute pain, which soon 
becomes constant and terribly severe, and the anxious look and 
appearance of suffering seen in peritonitis is observed. An ill- 
defined, rounded swelling extends upward from the iliac region 
(the point of greatest tenderness) toward the right loin, princi- 
pally due to the accumulation of fecal matter in the cecum. 
Its form and size may change from day to day, and if the disease 
subsides the swelling gradually disappears. 

Treatment. — The patient must be kept perfectly quiet and the 
diet be only liquid food, and but little of that. Not a bit of physic 
should be given, but opium should be freely used, just as in treat- 
ing peritonitis, and the same precautions must be observed be- 
fore beginning its use. When the disease subsides the greatest 
care must be used to prevent a relapse, for the disease is very 
prone to recur even after a considerable time. Give only liquid 
food for quite a number of days after all need for the precaution 
seems to have passed, and move the bowels only by use of in- 
jections. Very slight straining or exertion may result in per- 
foration, which is usually recognized at once by the signs of 
collapse, death quickly following. The disease usually runs its 
course in from fourteen to twenty-one days. 

In no other direction, perhaps, has modern surgery been more 
successful than in the treatment of appendicitis and typhlitis, for in 
the latter disease perforation of the appendix is one of the dangers 
to be greatly feared, a contingency easily avoided by a prompt and 
skillful use of the knife. 

PERITONITIS. 
(Inflammation of the Bowels.) 

Peritonitis is inflammation of the peritoneum (the thin, 
smooth, serous membrane lining the abdominal cavity and cover- 
ing the stomach, intestines, etc.). It is either acute or chronic, 
and is called local or general, accordingly as it affects a small 
portion of the membrane or spreads over the greater part or all 
of it. It is common to all ages of life, and sometimes seems to 



256 . GENERAL DISEASES. 

occur spontaneously, but can usually be traced to some one of a 
large variety of causes, such as blood poisoning, or other morbid 
condition of the blood ; an injury, as a wound, blow, or surgical op- 
eration ; tuberculosis, abscess, appendicitis, typhoid fever, Bright's 
disease, cancer, disease of the heart, lungs or pleura, and perfora- 
tions of the stomach or intestines; ruoture is also a frequent 
cause. 

Symptoms. — The attack is likely to be sudden, and the first 
symptom to be pain in a small part of the intestines, but soon 
spreading over every part of the bowels, and as the pain ad- 
vances tenderness comes and increases more and more until the 
slightest touch and the movements of breathing are painful. The 
bowels become greatly puffed out with gas, and the patient, 
to relieve the abdomen from tension as well as to protect it from 
the weight of the bed clothes, lies upon his back with his knees 
drawn up. 

There is vomiting, often of a deep green color, and a fever, 
with pulse sometimes reaching from ioo to 120 per minute in two 
or three hours after the beginning of the attack. The face is 
pale, haggard and anxious, the eyes sunken, the teeth set and lips 
tightly drawn, the expression of the whole face being one of ex- 
treme suffering. The disease usually runs its course in a few 
days, rarely in forty-eight hours, and sometimes lasts over a 
week. A case is recorded in which the patient recovered after 
forty-five days. Peritonitis is always very dangerous, but its 
termination depends largely upon the promptness with which 
correct treatment is begun, and the vigor and persistence with 
which it is conducted. When it follows perforations, tuber- 
culosis or cancer, the case is almost hopeless. 

Treatment. — The treatment must depend upon the cause, and, 
of course, be such as to allay inflammation as much as possible. 
Complete rest and abstinence from food are necessary through- 
out the entire disease. The patient should be put to bed and 
given neither food nor drink, his thirst being allayed by bits of ice, 
which are also valuable to suppress vomiting. All nourishment 
must be given by the rectum, either as suppositories or injec- 
tions. 

Cathartics of any kind should not be given. Dr. Alonzo 
Clark, who is an authority, says the bowels should be left entirely 
at rest until they recover their muscular tone, when they will expel 



GENERAL DISEASES. 257 

first the e"as, then the feces, or if, after the inflammation has sub- 
sided, they do not move of their own accord, injections may be 
given ; and adds that he has often left the bowels absolutely inac- 
tive in this disease for fourteen days without recognizable con- 
sequences. Generally, however, it is considered best by many to 
freely move the bowels at the beginning of the attack by means 
of an injection of water and soap, and then to give them ab- 
solute rest. 

During the acute period of the disease a cold water or ice 
pack should be spread over the whole abdomen to arrest the in- 
flammation, care being taken not to make it so large and heavy 
as to increase the discomfort of the patient. If cold water is used 
the cloths should be wrung from ice water and changed every 
ten or twelve minutes. Later, flannels wrung from hot water, 
or heated between folds of paper upon the stove, and liberally 
sprinkled with laudanum, should be applied instead of the cold 
ones. There is likely to be some doubt as to when the change 
from cold to hot applications should be made. Probably the feel- 
ings of the patient is the best guide, for in the acute stage the cold 
is usually well borne. Opium is the sovereign remedy in this 
disease. From five to ten drops of the tincture should be given 
every four hours as long as there is pain, but the use of opium 
should not be begun until a diagnosis has been made by the best 
physician within reach, for opium, by allaying the pain and tender- 
ness, destroys the most characteristic symptoms of the disease so 
that it may then be impossible for even the most skillful to make 
out the true nature of the trouble until the effects of the opiate 
have worn away. 

While recovery is taking place, the inflamed serous mem- 
branes sometimes become attached to each other, resulting in 
the folds of the bowels growing together, or growing to the walis 
of the abdomen, in such a way as to form strictures, or stoppages 
of the intestines, menacing health and even life. In some cases 
these adhesions can be broken up by hot and cold applications, 
using first one, then the other, changing every five minutes, and 
sometimes a surgical operation is the only resort. 

As this is usually a result of some other disease, and a very 
important part of all treatment is removal of the cause, no minute 
rules can be laid down for the management of all cases of peritoni- 
tis. Often the cause is so hidden as to baffle the most skillful. 

17 



258 GENERAL DISEASES. 

The best physician within reach should be called immediately, 
and the giving of opium postponed until after his examination, 
lest by its reduction of pain important symptoms be concealed. 
There are cases in which very large doses of calomel are advised 
by the best masters of the healing art. 



CHAPTER II. 

By R. E. McVev, M.D. 

TYPHOID FEVER. 

Typhoid fever is a germinal disease, and occurs most fre- 
quently during the autumn months. The germ is supposed to 
enter the system through the alimentary canal. Cess pools, 
dirty stables, barnyards, or any place that has become 
saturated with fecal matter, piles of rotting manure, and 
most other accumulations of filth, are its favorite breeding places. 
It is probable that in by far the greatest number of cases it is 
taken into the system in drinking water that has become con- 
taminated from some such source, but it may also be carried 
in milk that has been infected by dilution or from cans or other 
vessels that have been washed in impure water. In the same way 
fruits and other foods may become a medium of contagion. Oys- 
ters in beds near the mouths of sewers, or where sewage is de- 
posited by polluted currents, sometimes become infected with 
typhoid, and have been known to transmit the disease to persons 
eating them raw. Thorough cooking would have destroyed the 
germs. 

The alarming spread of this fever in our military camps during 
the late war was found by the board of investigation to have been 
due to an ignorant, if not criminal, disregard of simple sanitary 
rules. From feeding upon excrementitious matter in open latrines, 
swarms of house flies passed to the hard tack and other food of 
the troops, infecting it with millions of germs carried upon their 
rough, hairy little feet. Had all fecal matter been promptly and 
properly covered with fresh earth, and all water been kept pure, 
or thoroughly boiled before it was used in food or as drink, 
practically all of the dreadful scourge would have been avoided. 
In perfect health the acidity of the stomach is usually sufficient 
to destroy these germs, in which case they do no harm, but, enter- 
ing when this organ is in a deranged condition, they pass through 
to their favorite fields, the Peyerian glands in the last section of the 
small intestine. 

259 



260 GENERAL DISEASES. 

The first change wrought is in the blood; the second, in the 
spleen, which, by percussion, is found to be tender after the first 
chill, and later undergoes very marked changes, becoming en- 
larged and of diminished consistency. It continues to grow larger 
until the end of the third week, when it becomes soft like jelly, and 
is easily broken down, even by moderate pressure, and when re- 
moved from the body its cavities collapse. 

The capillaries of the lungs are filled with blood, a condition 
liable to result in static pneumonia. Changes in the brain and 
nervous system are only inferential. The salivary glands may be- 
come hard like cartilage, which explains the lack of secretion or 
moisture in the mouth. Changes in the glandular structures of 
the stomach give rise to digestive disturbances. 

The essential lesions of typhoid fever are found in the lymph 
structures of the intestine, the infiltrated cells being the lymphoidal 
cells. Four or five glands, near the valve joining the smaller to 
the larger intestine, are involved. There is soon an abnormal 
accumulation of blood and catarrh of the mucous membrane, and 
there is also enlargement from increase of cells in the glandular 
tissue. These abnormal changes may terminate by absorption 
or by resolution. The most frequent way is through separation of 
the dead tissues by a slough, or by the formation of typhoid ulcers. 
In the fourth week cicatrization commences, gradually the swollen 
edges of the ulcers heal, and, springing up from their bottoms, 
connective tissue membrane is formed ; the fever gradually sub- 
sides, and the patient slowly returns to health. 

Symptoms. — The length of time from the entrance of the 
germ into the system until the first symptom is probably unknown. 
The first manifestations of the disease are so mild and gradual that 
it is often hard for the patient to tell exactly when the attack 
began. The symptoms most commonly noticed at the onset are 
frontal headache with giddiness and noises in the ears, general 
pains in the limbs and back, with feelings of lassitude and illness, 
restlessness and disturbed sleep, slight and irregular chills, diar- 
rhea, loss of appetite, tongue furred with a thin whitish or yellowish 
coat, not extending to the tip and edges, which may be quite red, 
nausea and vomiting; but no disease presents more diversity at the 
beginning, and any of its symptoms may be either greatly exag- 
gerated or wanting altogether. 

Rarely at first, there is a moderate fullness from gas in the 



GENERAL DISEASES. 261 

bowels, with tenderness and a slight gurgling upon pressure in 
the right iliac fossa (the region in the right side of the abdomen 
in front of and near the upper part of the hip bone), but generally, 
and in the severer cases almost invariably, there will be some pain 
and tenderness in this spot by the sixth day, generally increasing 
as the disease advances, and in some cases becoming so great as 
to be unbearable, even if pressed slightly — a condition due to the 
ulceration of the Peyerian glands because of the poison generated 
within them by the typhoid germs. Sometimes there is much ab- 
dominal pain very early in the attack. In some cases diarrhea is 
the only prominent symptom for some days; in some, instead of 
diarrhea, there is constipation throughout the full course, of the 
disease ; and there are very rare cases in which there are no ab- 
dominal symptoms from first to last. 

The tongue may be quite clean for several days, even when 
there is high fever, and, when coated with the thin whitish fur, it is 
usually small and moist, but it may be laree and thickly coated, or 
red, smooth and glazed. There may be repeated bleedings at the 
nose. In a few days the fever begins to increase toward evening, 
and the temperature is soon found to be rising steadily from day to 
day, and from morning until evening and to decrease from evening 
until morning. This, in connection with several of the above 
symptoms, is a very strong indication of typhoid, especially if in 
four or five days the temperature is 103 or 104 degrees, but the 
other symptoms by themselves are not very positive signs, for 
they may be present in the early stages of other fevers, hence it 
may be impossible during the first few days to positively diagnose a 
ease of typhoid fever. 

It often happens that the patient does not feel sufficiently 
ill for some days to give up his occupation, thinking that there is 
not much the matter with himself, and sometimes a patient will 
walk during his entire illness. Although there may be some de- 
pression, the general appearance during the first week or ten days 
does not indicate any particular prostration ; there is nothing pe- 
culiar in the expression, and the face is normal in color, or it may 
be pale, or a pinkish circumscribed flush may be seen on one or 
both cheeks, varying in depth of tint, but not constant. The skin 
is usually hot and dry, but is sometimes moist. The pulse is 
quickened to 100 or 120 per minute, is rather weak and soft, and 
varies in frequency in the same patient, is sometimes readily in- 



262 GENERAL DISEASES. 

creased, and generally is more rapid at night. The lips are 
parched and dry; the mouth feels slimy; there is thirst, loss of 
appetite, and, frequently, nausea and vomiting; there is enlarge- 
ment of the spleen. The severity of the diarrhea varies greatly, 
the stools averaging from three to six per twenty-four hours, but 
sometimes as few as two, or as many as twenty, or even more. In 
a few days these discharges assume special characteristics, becom- 
ing thin, yellow (but sometimes brown, like coffee grounds), nearly 
fluid, and in appearance somewhat resembling pea-soup; very of- 
fensive, often ammoniacal and alkaline in their chemical reaction. 
When first passed they are uniform throughout, but, by standing, 
separate into an upper watery layer of brownish or yellowish color, 
and a lower layer or deposit, consisting principally of the remains 
of food, epithelium and mucus, corpuscles, blood and shreds of 
membrane. The urine is diminished and of high color. The 
sleep is restless and disturbed, but the mind at this stage is 
clear. 

There is usually a specific eruption in typhoid fever that is very 
diagnostic, but in quite young patients and in those over thirty 
this is often wanting. In rare instances it appears as early as the 
fourth day, but is not usually seen until from the seventh to the 
twelfth day, sometimes not until the twentieth. It may .appear 
upon the limbs, especially upon the thighs, and very rarely upon 
the face, but its usual locations are the abdomen, chest and back. 
The eruption consists of small papules of pin-head size or smaller, 
round, long, or oval in shape, slightly elevated, with rounded sur- 
face, of soft feel, and of a pink or rose color. They disappear upon 
pressure to reappear when the pressure is removed ; they come 
in successive crops, each spot lasting from two to five days, then 
fading away, the number present at one time ranging from two 
or three to twenty or thirty; they may continue to come until the 
thirtieth clay or longer, but the average time during which they 
appear is about fifteen clays ; they never become livid like flea-bites, 
and they are never present after death. 

Some cases of typhoid are mild throughout their entire course, 
some are severe at first and mild later, some are mild first and 
severe later, and some are severe from first to last. If the tongue 
remains moist throughout the attack, and there is no marked pros- 
tration, nor severe nervous manifestations, the symptoms thus far 
described may continue without any particular change until the 



GENERAL DISEASES. 203 

patient begins to recover. But if the disease is more severe, as it 
passes into the second or third week, the tongue is likely to become 
more heavily furred, the coating becoming brown and dry, and 
foul matter will probably gather upon the teeth and lips, often 
forming crusts, which increase as the disease advances ; but at any 
time during the attack the tongue may suddenly become clean and 
present a shiny, red appearance ; the odor of the breath becomes 
very bad ; the lips may become dry and crack, and a spreading 
eruption (herpes labialis) appear upon them. Sometimes the 
whole inside of the mouth becomes covered with dark colored in- 
crustations, indicating blood changes and a very serious condition. 
While the tongue is thus heavily coated, the taste may be so 
impaired that the patient cannot distinguish between bitter and 
sweet. There is likely to be great thirst all through the attack. 

As the disease progresses the patient emaciates and weak- 
ens — sometimes at the last being very much reduced; the face 
is more flushed; the whites of the eyes may become injected, the 
pupils dilated, and there may be inability to tolerate light. The 
headache is likely to be a dull, heavy pain, and to increase 
for the first week or ten days, or longer. There is pain in 
the back and limbs and throughout the whole body. From 
about the tenth to the fourteenth day the headache and gen- 
eral pains cease, and there is more giddiness and deafness. 
The hearing is nearly always impaired at this time and usu- 
ally so much that it is difficult for the patient to hear ordinary 
conversation. About the second or third week the mind becomes 
affected, as shown by drowsiness, mental confusion, or delirium. 
For a time the delirium occurs only at night, but it may become 
continuous, though remaining worse at night. When it is of a 
low type the patient usually answers questions correctly, but he 
may sink into a condition in which he will lie with half closed eyes, 
appearing to understand what is said but unable to make in- 
telligent replies. He may become noisy and violent, and may 
develop suicidal tendencies. 

The abdominal symptoms continue and are likely to grow 
worse, and there is danger as long as the abdomen is distended with 
gas, no matter what the other indications may be. The formation 
of the gas is thought to be due to changes in the mucous mem- 
brane lining the intestine, and, although the process is not well 
understood, it is evident that as long as the gas continues to form 



264 GENERAL DISEASES. 

intestinal changes are still in progress. In all cases of typhoid 
fever with abdominal distention, perforation of the intestine is a 
disaster greatly to be feared, and this danger continues until the 
patient is nearly well. 

The outlook is unfavorable in proportion to the height of 
temperature, and duration of the fever, especially if the morning 
remissions are but slight. Either a sudden rise or a rapid and 
extreme fall in temperature is a bad sign. 

Hemorrhage of the bowels occurs in about five per cent of 
the cases, and may take place at any time after the tenth day, but 
is most frequent between the fourteenth and twenty-fourth days, 
and may be independent of any known cause, it may be very 
slight, in which case, as in bleeding from the nose, the blood comes 
from the capillaries of the mucous membrane and serves to show 
that the patient has a hemorrhagic tendency ; or it may be very 
abundant, the patient sometimes discharging as much as eighteen 
ounces. In these cases the blood comes from an artery opened 
by an intestinal ulcer, and it may not immediately make its ap- 
pearance externally ; indeed a patient may die -from intestinal 
hemorrhage before any blood is voided from the rectum. Such a 
hemorrhage is indicated by a sudden fall of two or three degrees 
in temperature, accompanied by extreme prostration. Unless 
death soon follows severe intestinal hemorrhage, peritonitis is very 
likely to set in. Even in the latent or "walking" form of typhoid 
fever, sudden death may occur either from perforation or intestinal 
hemorrhage. 

In some cases there may be constipation throughout the 
entire illness, and in some diarrhea may not come until the third 
week, although the second week is the most usual time for its 
appearance. A mild diarrhea during the entire course of the dis- 
ease is a favorable symptom. Many cases terminate about the 
twenty-first or twenty-eighth day ; the average duration of fatal 
cases is said to be about twenty-two days, but death may occur 
within the first few days, and sometimes cases run seventy days or 
longer and terminate in recovery. The disease is especially severe 
upon those who have not become acclimated to the place in which 
they are while ill. The great majority of patients fully recover, but 
others are doomed to permanent ill-health thereafter, in some cases 
due to constrictions of the intestines, in some to the destruction 
of many of the villi of the digestive tract by the intestinal ulcers 
characteristic of the disease. 



GEXERAL DISEASES. 265 

One of the first indications of recovery is a moistening of the 
tongue along its edges, which gradually extends over its entire sur- 
face. The temperature which in the evening may have been from 
103 to 106 degrees, or even 107 or 108 degrees, declines very 
gradually, the first indication of which is seen in more distinct 
morning remissions. In three or four days the evening tem- 
perature falls, and the morning remissions considerably increase, 
so that a difference of two or three degrees, or more, occurs be- 
tween the morning and the evening. The length of time until the 
evening temperature becomes normal differs greatly. Complica- 
tions may ]ead to irregularities, and a relapse may cause the fever 
to rise in the same irregular manner as at first. 

No part of the illness is attended by greater danger than that 
of convalescence. Of this the patient should be fully advised, 
and the nurse or attendant must constantly be very alert and 
firm. As the fever subsides the appetite increases until it be- 
comes a controlling passion, so great is the craving of the tissues 
for food. Many a patient has lost his life at this stage by eating 
a banana, a little scraped apple, or some other longed-for and 
seemingly harmless article of food. As great care must also be 
taken in regard to exercise and exposure, until the patient is quite 
well. Visitors should not be admitted, and excitement of every 
kind should be avoided. Even so slight a strain as sitting up in 
bed too soon may prove serious. Through pumping poisoned 
blood so long, and having to draw its nourishment from it, the 
heart has become very weak and tender, and the patient must not 
add to its work, either by exercise or posture, until it can in some 
measure recover its old-time strength and tone, and he should then 
only Aery gradually resume such gentle activities as short walks 
and rides. 

Typhoid is prone to relapses, and they may recur several 
times. There may be only a rise of temperature, but usually a 
relapse is attended by all the prominent symptoms of the first 
attack, except that everything is likely to be more condensed 
and last a shorter time. It may or may not be due to mistakes 
in diet or overexercise. It is probably caused by the involvement 
of one or more glands, which, until this time, had escaped. The 
claim that it is a result of reinfection has not been proved. It 
generally comes from seven to ten days after the temperature 
has become normal, but the interval may be longer than that, 



266 GENERAL DISEASES. 

and it may be much shorter, in some cases beginning before the 
evening fever has all gone. The fever rises more rapidly than it 
did at first, but in the same way, being lower in the morning 
and higher in the evening, and its duration is shorter in the re- 
lapse, seldom reaching fifteen days; its decline, too, is more 
abrupt, but it may run higher than it did in the first attack. The 
eruption returns, often on the third day, the spleen enlarges again, 
the discharges from the bowels may or may not resume the liquid 
form, and all kinds of complications are liable to arise, but the 
consequences of a relapse are not usually as dangerous as sup- 
posed, and, with proper care and nursing, the patient generally 
recovers. 

Malaria may appear at any time, hence is one of the complica- 
tions to be guarded against. Many cases of so-called remittent, 
bilious or malarial fever are modified typhoid. It should be 
remembered, too, that malarial fever and typhoid fever are no 
protection against each other ; on the contrary, either may pre- 
dispose to the other by reducing the system until it is less capable 
of resisting disease. 

Treatment. — The first factor in treatment is the proper 
nourishment of the patient ; the second is the control of his tem- 
perature without debilitating* him. For the latter purpose, one 
drop of the tincture of aconite with one-sixteenth of a grain of 
morphia may be given every two hours, or at such longer in- 
tervals as may be required to keep the temperature below 103 de- 
grees. Also give the patient- quiet rest. As already stated, a 
positive diagnosis of typhoid fever cannot always be made until 
about the fifth day. 

The abortive treatment consists of calomel, iodine and the 
mineral acids. Three grains of calomel, twelve grains of the bicar- 
bonate of soda and twelve grains of the sugar of milk should be 
mixed, divided into twelve powders, and one given every hour. 
Calomel is a germicide, but its chief value probably lies in its 
stimulation of the biliary functions of the liver, for bile is the great- 
est antiseptic known for the prevention of decomposition in the 
alimentary canal. The calomel should be given only in small 
doses and continued only five days, after which give sulpho-car- 
bolate of zinc every three hours. The calomel treatment in much 
larger doses was thoroughly tried in the army during the war of 
the Great Rebellion, but the mortality was over sixty per cent. 



GENERAL DISEASES. 267 

In Germany the treatment, as given by Leibermeister, is one 
dram of the tincture of iodine, and three drams of the iodide of 
potassium, with one ounce of water ; dose, three drops in a wine- 
glass of water every two hours. 

In this country the "carbolic acid treatment'' has been used 
instead. It consists of one dram of carbolic acid, one dram of the 
tincture of iodine, and two drams of glycerin, mixed together, and 
doses of four drops each given every four hours; but, although 
it has many advocates, its success has not by any means been an 
unqualified one, and the same is true of every combination of 
antiseptics yet devised. No agent has been found by which 
typhoid germs in a human intestine can be dislodged or overcome 
without killing the patient, but the work of these parasites is self- 
limited, and when their race is run, and only then, the reparative 
energies of the system can be relied upon to effect the cure. 
The process cannot be hastened. Upon the vitality of the patient 
must depend the success of the final effort ; hence, if the calomel 
treatment of the first five days proves unavailing, and the fever 
becomes well established, instead of trying to abort it with power- 
ful medicines, give only such remedies as are needed to ward off 
complications, control the bowels, temperature, pulse and nerves, 
and, by careful feeding and nursing, keep up the strength until 
the diseased glands shall heal. 

To lubricate or coat over the intestines and soothe the ulcer- 
ated glands, as well as to check excessive bowel movement, noth- 
ing is better or safer than bismuth ; and to stimulate the liver, and 
quiet the nerves, Dover's powder is excellent. The two are best 
given together — five grains of the subnitrate of bismuth with two 
or three grains of the Dover's, once in three or four hours. Should 
constipation set in, the quantity of bismuth may be diminished. It 
is so important in this disease to keep the bowels quiet, it is better 
not to give laxatives as long as there is a passage once in two 
days, but should a longer time intervene (and a good movement 
cannot be obtained by means of a rectal injection), a mild cathartic 
must be given. A small close of castor oil is best, repeated every 
four hours until action is obtained. All severe cathartics must be 
carefully avoided, since, by causing violent peristalsis, they might 
do great harm by irritating the intestinal ulcers and increasing in- 
flammation. It is well for the patient to spend two-thirds of his 
time in sleep, but if there is too much stupor, less Dover's should 



268 GENERAL DISEASES. 

be given, the quantity to be diminished as the case requires. In 
such cases it will usually be best left off in the morning and given at 
night. 

When the temperature rises above 103 degrees, it should be 
reduced by sponging with water as warm as can be borne. Dr. 
Curry advocated the use of cold water, as the greatest of anti- 
pyretics, for the reduction of temperature, and many have fol- 
lowed his theory; but I get better results from the use of warm 
w r ater. The temperature should be lowered by evaporation, not 
by the application of cold, which may drive the blood from the sur- 
face, to the great central vessels, engorge them, and throw ex- 
cessive work upon the heart, already overtasked and in a feeble 
condition. There is danger of heart failure. Everything that 
excites, shocks or weakens should be studiously avoided. Warm 
water, with its consequent evaporation, controls temperature 
quite as well as cold water, without the risks from depression. It 
is safer, too, to apply it with a sponge than to put the patient 
into it. Keep him as quiet as possible, and out of cold draughts. 
Sponge first the face, then the hands and arms, next the trunk 
and lower limbs, repeating the process every fifteen to thirty 
minutes until the temperature yields, but do not expect to reduce 
it more than two, or, in some cases, possibly three degrees. 

The patient should drink freely of coir 1 water; give him all he 
wants, for it will lower temperature as well as quench his thirst, 
and by stimulating the kidneys, help in the elimination of poisons. 

When the pulse rises above 105 beats per minute give from 
one-sixtieth to one-thirtieth of a grain of the sulphate of strychnia 
every four to six hours, until the rate is reduced. It is kept ready 
prepared in tablet form at the drug stores, and is one of the best 
heart tonics known. 

Quinine during the early part of the attack is of very little 
service in typhoid, but, in the later stages, it has antipyretic 
value, wards off malaria, and serves as an excellent tonic. It may 
be given in from two to four grain doses, every two to six hours ; 
or it may alternate with the strychnia, or may be given in the fore- 
noon only, the Dover's powder being given instead in the after- 
noon and at night. 

In case there is any distention of the abdomen with gas, or 
much abdominal pain, liberally sprinkle a soft woolen cloth with 
turpentine, spread it over the abdomen and leave it there until 



GENERAL DISEASES. 269 

the skin is well reddened, but not long enough to cause a blister, 
then remove it and in its place apply a similar cloth without the 
turpentine. This may be repeated at intervals of eight or ten 
hours as the case may require. Do not apply warm or hot cloths 
or poultices to the abdomen in treating this disease. 

Should the limbs and feet become lame with a soreness akin to 
rheumatism, they can usually be much relieved by gentle massage. 
If the back and hips become inflamed, bathe them each day with 
alcohol to prevent bed sores. 

While the fever lasts the diet must consist of fluids, and, dur- 
ing the return to health, the restoration of solid foods must be 
very gradual. Milk is the proper food, and, in cases where it 
agrees, should be the only food. It is of the greatest importance 
that the strength be sustained as well as possible, and to do 
this the milk must be given with careful regularity, not oftener 
than once in three hours, and in as large quantity as the patient can 
digest. If curds appear in the stools, the quantity must be dimin- 
ished until the right measure is found, after which this amount 
must be given steadily. If its casein disagrees with the patient, 
the milk should be modified by adding barley water, lime water, or 
some other diluent. Sometimes milk from a different cow is what 
is needed. Should the milk continue to disagree, nothing is bet- 
ter as a substitute than beef tea, or will do more to keep up the 
strength ; give from two to hive teaspoonfuls every two hours. For 
its preparation see "Nursing." 

When the fever has gone, and solid, easily digestible foods are 
gradually restored, maltine with pepsin and pancreatin should be 
given, a teaspoonful after each meal ; or five drops of nitro-hydro- 
chloric acid may be given instead. Let it not be forgotten that 
there is now great danger from overfeeding and overexercise, 
and that until the patient is quite well his condition is always 
critical. In some cases the hydrochloric acid increases the hunger 
so much that it should not be given. 

The sick-room should be removed as far as practicable from 
the family living rooms, should have an abundance of sunlight, 
and its air must be kept pure by good ventilation. All milk and 
water used by the family, unless the supply be hydrant water, 
known to be pure, should be boiled. As the spreading of the dis- 
ease is wholly from the excreta, all discharges from the patient 
should be thoroughly disinfected (see "Disinfection and Disin- 



270 GENERAL DISEASES. 

fectants"), and buried at a safe distance from cisterns and wells. 
As an additional precaution, it is wise to drop a five-grain bi- 
chloride of mercury tablet into the chamber after each cleansing, 
and add a pint of water. / 

MALARIAL FEVER. 

Malarial fever is a disease caused by the development and 
multiplication in the blood of a germ called plasmodium malaria. 
There are three types or forms of the parasite, and they do their 
mischief by destroying the red-blood corpuscles. As they are 
exceedingly minute, and can be detected only by a skillful micros- 
copist with the aid of a good instrument, we will not describe the 
various forms nor enumerate the differences which distinguish each 
from the others; we will, however, observe that the form called 
the tertian lives forty-eight hours ; that another, the quartan, has 
a life-cycle of seventy-two hours ; and that the aestivo-autumnal 
is thought to live but about twenty-four hours, but, as with all 
other living creatures, their lives may be shortened or lengthened 
by external conditions. Their natural life-cycle terminates in 
segmentation — the process by which each germ breaks up or 
separates into from six to twenty segments, whereupon, by burst- 
ing the membrane of the containing corpuscle and escaping into 
the blood, each of these parts attacks a fresh red-blood cell, in 
which to live and develop into a mature organism like the parent 
from which it came. 

The paroxysm (the chill and the fever), which in this dis- 
ease is always intermittent, appears to follow the act of segmenta- 
tion so closely that, in the tertian and quartan forms, they occur 
at nearly the same hour every day, or every second or third day, 
accordingly as the patient has been infected with one or more than 
one crop of the same or different forms of the parasite. The 
aestivo-autumnal type differs from the others also in being less 
regular in its development in crops, in being smaller, and in its 
more rapid destruction of blood cells. It is often the cause of the 
irregular malarial fever seen in the fall of the year, and is destroyed 
by quinine less readily than the other forms. Koch has proven 
this form to be identically the same as tropical malaria. 

It is thought that all three forms get their food entirely from 
the blood, and probably from the red-blood corpuscles. As each 
voting p-erm makes its abode in a red-blood cell, feeding, maturing 



GEXERAL DISEASES. 271 

and segmenting there, each crop or brood destroys a very great 
number of cells, and it has often been found that after a paroxysm 
from ten to fifty per cent of the normal proportion of these red 
cells are wanting, and that their coloring matter has been left as 
refuse in the blood. 

How the first germs get into the blood is not certainly known, 
but it is probable that, in by far the greatest number of cases, 
they enter the body with the drinking water. Strong proof of this 
is found in the following facts, which have been widely quoted : 
"At Brownsville, Texas, is a military post, which takes its water 
from the Rio Grande. It is surrounded by what have long been 
considered most typical malarial conditions, such as swamps and 
stagnant lagoons. Until 1890 the hospital record of this post was 
by far the worst of any in this country in the proportion of its 
malarial diseases. The medical report for that year shows that 
its hospital admissions of malarial cases were 1,876 for each 1,000 
men stationed there, and this was the usual proportion. The next 
year an ice plant and condensing apparatus for supplying distilled 
water were put in at this post, and so great were the advantages 
derived from the pure water that it was immediately furnished, for 
all drinking and culinary purposes, to the entire command. In 
the following year the number of admissions for malarial diseases 
were but sixteen for each 1,000 men, or less than one per cent of 
what the regular number had been from the first establishment of 
the post. There had been no change in anything except the 
drinking water. The swamps and lagoons were still there, and 
the unhealthy city of Brownsville, in which impure water was 
still used, remained on their borders, and the few cases of malaria 
that still entered the hospital may have been caused by soldiers 
drinking water when away from the post. This would seem, 
therefore, to prove that the malarial troubles were wholly due to 
impure drinking water, and not at all to the air that was breathed, 
and that malarial diseases are produced by water-borne germs."* 

It is believed by Professor Koch of Berlin and many other 
careful investigators, that the infection is also disseminated by 
mosquitoes — these agents playing much the same part in malaria 
that is played by ticks in the cattle disease, known as "Texas 
fever." Human blood, known to be pure before being absorbed 
by them, has been found, a little later, abundantly impregnated 

*Address of Prof. J. B. Johnson before the Kansas State Board of Health. 



272 GENERAL DISEASES. 

with malaria germs, thus proving that the mosquito sometimes 
carries them within its body, and it is probable that it may also 
occasionally carry them upon its bill from the contaminated pools 
at which it drinks. 

A strong, vigorous person, through the natural resistance of 
his system — perhaps by the acidity of a healthy stomach, perhaps 
by an antitoxine formed in the blood for that purpose — is able to 
overcome the few germs which ordinarily effect an entrance, but, 
coming when the blood is reduced or the stomach is disordered, 
as from disease, fasting, fatigue, dissipation, or the effects of heat 
or cold, or coming in large numbers for a long time, as from re- 
peatedly drinking infected water, the natural resistance is finally 
overpowered', and malarial fever results. 

Symptoms. — The first symptom is depression of the brain and 
nervous system. Soon there is a yellow, jaundiced appearance in 
the eyes and skin, caused by the coloring matter of the destroyed 
blood cells, which is also carried to the liver, spleen and other 
organs. The temperature begins to rise before the chill begins, 
and usually reaches its highest point while the chill is on. There 
is an increased amount of urine and changes in its composition 
which give it a clear, watery appearance. This occurs about two 
hours before the chill. There is more or less nervous disturbance, 
and as the disease progresses there is constriction of the surface 
vessels, which drives the blood to the central organs and engorges 
them. This is the period of chill, and it lasts from thirty minutes 
to half an hour, when reaction comes. The surface vessels now 
dilate and become over-filled with blood. This is the fever stage. 
Finally these distended vessels are relieved through sweating. 
There are three stages to each attack — the chill, fever and sweat. 
An interval follows during which the patient feels that he is well, 
its length depending, as we have seen, upon the form of the germs 
and the number of crops with which he is infected. 

Treatment. — To relieve the liver, spleen and other organs, use 
the following : Calomel, three grains ; bicarbonate of soda, twelve 
grains, and sugar of milk, twelve grains ; mix and divide into twelve 
powders, then give one every hour until the bowels move freely. 
Both as a germicide and as a support to the nervous system, 
quinine is the remedy. It should be taken in three-grain doses in 
coffee, capsules, or lozenges, the hard coated pills not being as 
good. Children take it best in yerba santa. This treatment should 



GENERAL DISEASES. 273 

be continued until all the symptoms have subsided. To do its 
best work the quinine should be given six hours before the chill, 
or during the sweating. If there be great pain, or an accompany- 
ing diarrhea, mix with the quinine from one-sixteenth to one- 
eighth of a grain of morphia. If, when the urine first begins to 
increase, we give one-fourth of a grain of pilocarpine, we will an- 
ticipate and prevent the recurrence of the chill and fever, and tide 
the patient over to the sweating stage. 

As already shown, malaria can be very largely prevented 
by properly observing the laws of its development and dissemina- 
tion. Except distillation, boiling is the best method of freeing 
water from all bacterial germs, and in a malarious country, espe- 
cially in its most malarious seasons, all the water used for drink- 
ing and culinary purposes should first be boiled. Malaria is most 
prevalent where there is most decaying vegetable matter, and this 
occurs not at times of greatest rainfall, but when the wet earth 
and low lands are drying out ; and the danger reaches its height 
during drouths after very wet seasons. Draining millponds and 
lakes is attended with danger while their bottoms are drying up, 
but having been thoroughly dried and cultivated with crops they 
become healthful. On the other hand malarious swamps have been 
robbed of their terrors by flooding to a depth sufficient to keep 
them covered with water. 

Again the amount of malaria in a region appears to be in- 
directly proportional to the amount of plant growth going on 
there at the same time, a condition to be expected if we remember 
that the poison consists of germs- whose development is retarded 
by the excessive moisture, prevailing during the periods of most 
rapid growth. 

While water is indisputably the principal medium for dis- 
seminating the infection, it has not been ascertained that the germs 
may not be borne in the air to the lips and thence carried to the 
stomach in saliva, or that they may not enter the blood through 
the lungs, hence, the old safeguards against miasmatic air should 
not be discarded, even though of less importance than formerly 
supposed. In brief, they were as follows : Winds blowing from 
off swamps, marshes and low lands impregnated with decomposing 
matter are laden with malarial germs, so in choosing a home let 
it not be in these currents, but where the prevailing winds will 
blow toward the pestilential centers, rather than from them. It 

18 



274 GENERAL DISEASES. 

is not usually thought that the poison is thus carried far, but in 
high winds it may be borne a considerable distance. Forests 
interpose a barrier and orchards and groves afford valuable pro- 
tection. Plant them about the home, especially on the sides from 
which malaria is most likely to come, using care not to shade the 
house itself much ; and cultivate and crop the surrounding land, 
especially all neighboring low land. Grass is far less dangerous 
than growths of weeds. 

As the germs are more numerous near the ground than a 
little above it, sleep upstairs. Because of the destructive influence 
of sunlight upon germs, malaria is not as intense during the day 
as at night, hence in malarial regions avoid exposure to night air. 
Jf you must be out at night, or in the dews and fogs of early morn- 
ing, wear flannel next the skin, and dress warmly, for taking cold 
predisposes to this disease. Chilling is one of the most dangerous 
of all the predisposing influences — so reducing systemic resistance 
that it may be unable to longer overcome malarial germs. See to 
it that children are properly covered during the cool part of the 
night and early morning. The same is true of the condition pro- 
duced by long fasting, so guard against exposure before breakfast ; 
fortify the system by taking a drink of hot coffee before beginning 
outdoor work in the early morning. Its preventive power against 
malaria is considered great. On damp mornings in summer a lit- 
tle fire in the living rooms is a wise precaution. 

Lime is thought to destroy malaria, if applied fresh and in 
considerable quantities. It should be freely spread upon freshly 
upturned earth in cities, as when grades are being changed, or 
trenches dug for pipes, sewers, etc., for such ground is usually 
full of malaria. Smoke and fumes from burning sulphur, 
petroleum refineries, lime-kilns and gas works are also said to be 
preventives. 

If much exposed to malaria, quinine is the surest and best anti- 
dote. Many recommend it in two-grain doses morning and even- 
ing, when forced to remain in very malarious regions, such as 
abound in low, tropical countries ; but in the temperate zones it is 
better to use it only in case of attack, since the changes in the sys- 
tem, resulting from constant absorption of the drug, may prove 
more serious than the disease itself. 



GENERAL DISEASES. 275 

INFLUENZA. 
(La Grippe. Grip.) 

Influenza is a specific, highly infectious fever, characterized 
by nervous symptoms and great debility, and often accompanied 
by catarrhal inflammation of the respiratory and digestive organs. 
It was mentioned by Homer, who wrote about 800 B. C, and is 
known to have been epidemic in Ireland in the fourteenth century. 
Starting from Malta in 15 10, it quickly swept over all Europe, 
"scarcely missing an individual," and it has been widely epidemic 
there nearly a hundred times since. 

It has been common to all ages and altitudes, climates and 
countries, hot and cold, wet and dry, regardless of surroundings, 
and nothing can better prove the definite character of the disease 
than the similarity of the symptoms it has shown through all these 
centuries amid the most widely differing circumstances and en- 
vironments, and although the improved hygienic conditions of 
the present may have reduced the amount of mortality, they 
do not appear to have influenced the diffusion of the epidemic. 

It has many names , as lightning catarrh, epidemic bronchitis, 
and epidemic catarrhal fever. The French term, "la grippe," is 
widely used and means to seize, so suddenly does it lay hold of its 
victims. The English word "grip" is quite as proper. It is due 
to a short-lived germ, which secretes a poison of very great vir- 
ulence, for in this, as in most other infectious diseases, it is not 
the number of parasites that circulate in the blood, but the viru- 
lence of the poison they produce that measures their capacity for 
injury. No other malady is attended by a. greater variety of 
severe symptoms, or followed by more sequels of a serious nature, 
leading a little later to loss of health, if not to death; and it should 
be understood that while grip often lasts only two or three days, 
and in some cases the patient hardly knows that he is ill, to the 
infirm, the aged and the predisposed it is a very dangerous 
disease. 

In uncomplicated cases death rarely results, but there are 
few disorders of the nervous system that are not liable to occur, 
either as its accompaniments or consequents. It was long con- 
sidered a catarrhal affection, and there is much about it that is not 
yet understood, but the most careful investigators now regard it 
as a nervous fever, caused by a poisoning of definite nerve centers 
by the toxine produced by the micro-organisms, the parts affected 



276 GENERAL DISEASES. 

in each case depending upon the center that is attacked, the seri- 
ousness of the disease, upon the power of resistance possessed by 
the patient. Catarrhal inflammations may or may not be present. 
They are often very important features, but in nearly twice as 
many cases the nervous symptoms predominate, and there have 
been frequent cases of grip in which the patients neither coughed 
nor sneezed. 

The period of incubation varies greatly ; as in some cases the 
symptoms come on immediately after exposure, while in others 
they do not appear until several days after. One attack does 
not confer immunity, and a patient may suffer two attacks during 
one epidemic. 

Symptoms. — A sharp, short attack of fever; great physical 
and mental prostration ; severe pain in the head, body and limbs ; 
often pain in the eyeballs, much increased upon motion ; a sense 
of fullness across the forehead ; sleeplessness, sometimes delirium, 
convulsions, coma, paralysis, deafness and loss of smell and taste. 
Tonsilitis, bronchitis, croup, heart complications, catarrh of the 
mucous membranes or pneumonia may follow. The fever attack 
is usually very sudden, the temperature soon reaching ioo degrees 
to 103 degrees. Althaus reports a case in which the temperature 
was 109 degrees for three days, then soon subsided and the patient 
recovered; and adds: "There is no correspondence between the 
degree of heat and the severity of the illness, as in the eruptive 
fevers, and in other acute diseases." 

In uncomplicated cases, in otherwise healthy people, the 
fever rarely lasts longer than one, two or three days, and the 
symptoms often leave as suddenly as they came. Those cases do 
best in which high fever is followed by perspiration and loss of 
heat. When the fever lasts more than two or three days it is due 
to unfavorable complications, or to the age, weakness or pre- 
existing diseases of the patient. 

Grip is likely to engraft itself upon the remnants of any 
old disorder still lurking in the system, and rouse it to greater 
virulence than it ever before displayed ; thus heart disease may be 
suddenly increased to such dangerous proportions that even a 
little change of position, or slight effort of any kind, may prove 
fatal ; syphilitic poisoning of long standing and sluggish form may 
be roused to uncontrollable activity ; and alcoholism be speedily 
advanced to delirium tremens of more persistent type than is ever 
shown when caused by alcohol alone. 



GENERAL DISEASES. 277 

Grip is not as common in children as in adults, but they are 
by no means exempt. It often begins its attacks upon them with 
intense headache, vomiting, constipation, grinding of the teeth, 
stiff neck, delirium, convulsions and coma. Sometimes uncon- 
sciousness comes so suddenly as to resemble apoplexy, and the 
alarming features then subside in a day or two. 

In the nervous form, headache, next to fever, is the most 
characteristic feature. It is often associated with backache of very 
severe type, especially in the loins. There is also liable to be sore- 
ness and stiffness of the whole body and great pain in the limbs, 
causing tremors, twitches and cramps. 

Treatment. — Many cases are so mild as to need no treatment, 
other than light diet and precautions against taking cold. In the 
severer attacks first give the following: 

Hyoscyamus extract fifteen grains 

Quinine , one-half dram 

Camphor one-half dram 

Socratine aloes five grains 

Mix and put in thirty capsules, then give one every four hours 
until relief is obtained. The patient should take a hot foot-bath, 
lasting ten or fifteen minutes, kept as warm as can be borne by 
adding more hot water from time to time ; then drink copiously of 
hot lemonade and be covered up warmly in bed. 

As great depression attends this disease it is very important 
to keep up the strength of the patient as much as possible ; hence 
debilitating remedies of every kind should be avoided. Bronchial 
congestion and sore throat may be greatly relieved by the inhala- 
tion of steam. (See acute sore throat.) Should pneumonia de- 
velop, give five-grain doses of carbonate of ammonia in a tea- 
spoonful of yerba santa every four hours. It must be remembered 
in all such cases that poison in the blood is the primary trouble 
and that it will admit of no depressing remedies. As much as 
possible avoid weakening the patient. The bronchitis and 
pneumonia are secondary affections, and their suppression will 
soon follow the use of supporting measures. In such cases, besides 
the other treatment, give four ounces of yerba santa maltine, 
such as is kept at the drugstores, in one teaspoonful doses three 
times a day ; or an ounce of good wine three times a day with 
meals. 



278 GENERAL DISEASES. 

If taken in the beginning, from three to rive grain doses of 
quinine three times a day may terminate the attack. In cases 
of slow recovery the elixir of iron, quinine and strychnia, found 
ready prepared at drugstores, in teaspoonful doses three times a 
day after meals, will restore strength and vitality. 

The patient should guard carefully against taking cold, and 
not resume work too soon, for very often when in a fair way to 
recovery a little imprudence leads to relapse, or challenges a 
train of ills, when, because of its depressed condition, the system 
is not able to cope with any one of them. The aged and infirm 
should remain housed in well warmed rooms during an epidemic 
of grip, and take a nourishing diet ; for the healthy and well fed 
are best prepared to resist the disease. 

DIPHTHERIA. MEMBRANOUS CROUP. 

Diphtheria means membrane. It is a fungous disease, wholly 
due to a specific germ, the Klebs-Loffler bacillus, a microscopic 
plant so minute that the shell of a mustard seed would hold ten 
millions of them. Just as the growth of wheat, corn, or any other 
form of larger plant-life, is subject to certain laws, so the dissemi- 
nation, growth and multiplication of these little plants, these deadly 
disease germs, are controlled by certain conditions ; if these con- 
ditions be unfavorable the germs will cease to multiply; if very 
unfavorable, they will die. It is now thought that, except in 
warm milk and when artificially cultivated, they never grow and 
multiply outside an animal body, and it is known that although 
they may live in the human throat at any time from infancy to old 
age, they grow fastest and flourish best in the throats of children 
from two to ten years old. Why this is so no one can tell, 
but it is known that it is so. 

Dr. Charles T. McClintock, of Detroit, says: "As larger 
plants, under unfavorable conditions, may barely keep alive, with- 
out increasing or spreading to adjoining soil, so it has been shown 
that diphtheria germs may at times live in the throat of an adult, 
but merely live and not multiply, because of the unfavorable 
conditions, and the individual, therefore, not have the disease, 
diphtheria. 

"The- germs grow best at about the temperature of the human 
body — 94.4 degrees Fahrenheit. They cease to multiply when the 
temperature falls to 68 degrees, and this is one of the reasons they 



GEXERAL DISEASES. 279 

do not multiply in sewage. They also cease to grow when the 
temperature is raised a few degrees higher than that of the body 
and are killed at a heat of 136 degrees to 140 degrees. The germs 
grow only where there is moisture. They may remain alive but 
do not multiply in dried sputum, in dus.t, on dry clothing, etc. 
Dried on cloth they may live for one or two months, and there 
are instances of apparent infection from rooms, clothing and bed- 
ding which seem to show that the germ in a dry state may live for 
months, possibly years. Like other particles of dust, the germs 
cling to a moist surface. Neither they, nor any other disease 
germs, are to be found in the breath of the patient, so, though 
they be emptied by million. s into the sewers, they do not. cannot 
rise with the sewer gas. In coughing and gagging, the patient 
will throw out particles of saliva and of the diphtheritic membrane. 
These may contain thousands of the germs. Many a physician has 
paid with his life for his care in examining and treating the throat 
of a diphtheria patient, the coughed-out particle striking his eye, 
nostril or mouth, piving him the disease. Contrary to the condi- 
tions obtained in higher plants, sunlight is fatal to these, as to all 
disease germs — even the most resistant of them being killed by a 
few hours' exposure to the direct rays of the sun. The lesson to 
be learned from this is obvious, yet, through fear of faded carpets, 
we shut out the best of all disinfecting agents." 

It is probable that an unsound throat, or a debilitated condi- 
tion, even in an adult, facilitates the development of diphtheritic 
germs, but that vigorous health prevents them from increasing to 
numbers capable of working any injury, unless it be by finding 
their way. as through a public drinking-cup, kissing, or some other 
medium of transmission, to the throat of a more susceptible per- 
son. The custom in our schools of using books and pencils fur- 
nished at public expense and indiscriminately passed from one 
child to another, cannot be too strongly condemned, for even 
though the pupils may be instructed never to touch them to their 
lips, they must ever be a source of constant danger. 

The quantity of these germs present in any case bears a close 
relation to the intensity of the disease. As they multiply it ad- 
vances, and as they diminish it subsides. They are divided into 
two classes — the aerobic and the anaerobic. The first class live 
where they can get air. and cover the membranes of the throat 
as grass covers a lawn. The second class burrow in the tissues and 



280 GENERAL DISEASES. 

live without air. These two kinds of fungous growths, and the 
exudation they produce, make up the membrane of diphtheria. 

In simple inflammations of the throat there are always pres- 
ent certain forms of germs which, in case diphtheria sets in, are 
displaced by the diphtheritic germs, which are the stronger and 
more virulent. In this way we account for a simple sore throat 
sometimes suddenly changing into a diphtheritic one, and, for this 
reason, when diphtheria is prevalent, a sore throat should be care- 
fully watched from day to day. If an exudation appears it is evi- 
dence of the presence of diphtheria. 

Symptoms. — The symptoms of typical diphtheria are quick 
pulse, fever, white streaks on the tonsils, scant high-colored urine, 
thin white coating of the tongue, and loss of appetite, accompanied 
by more or less nervous prostration. In grave cases the pulse is 
1 20, the temperature from 100 degrees to 103 degrees, the breath 
is fetid and there is likely to be vomiting. Albumin appears in 
the urine about the third or fourth day, and about the same time 
the exudation appears in the throat and extends from the pharynx 
up into the nasal cavities, forming into a thick, leathery membrane. 
The glands at the angles of the jaws and under the chin become 
swollen, their connective tissues having become infiltrated with 
the diphtheritic virus, which has also been carried throughout the 
whole system. This poison, produced by the growth of diphthe- 
ritic germs, has been demonstrated to be analogous to that of cer- 
tain venomous serpents. 

For four or five days after the formation of the membrane 
it does not seem to change much, then it loosens at its edges and 
rolls up toward the center, where it finally also loosens and becomes 
free, the parts beneath being left bare and covered with red points. 
If the patient is to recover no new membrane forms, but if his 
vitality is greatly reduced this cast-off membrane is replaced by 
another which may be more extensive than the first, project into 
the larynx, and even into the trachea, diminishing the supply of air 
and endangering the patient's life. 

Treatment. — The treatment should begin with two grains of 
calomel in a tablespoonful of water, mixed with nothing else, and 
swallowed slowly, that it may lodge in the throat and act as a 
germicide. This should be repeated every two hours until the 
bowels move freely. Instead of this, some prefer to use the 
bichloride of mercury, one-fourth of a grain to four ounces of 



GENERAL DISEASES. 281 

water, giving- a teaspoon ful of the mixture every four hours. 
While giving this, all discharges from the bowels should be care- 
fully examined, and if any green color appears in the dejections 
the medicine must be stopped immediately, or changed, lest 
mercurial poisoning follow. 

Pilocarpine in very small doses, one one-hundredth of a grain, 
may be given to prevent the attachment of the membrane upon 
the surface of the throat, by the intervention of mucus, the flow 
of which is greatly stimulated by this drug. If the patient becomes 
weak he may be given two grains of quinine every two hours until 
the strength is restored. In case of marked depression alcoholic 
stimulants may be used. 

Do not try to remove the membrane by tearing it off, for the 
raw place thus caused w T ill surely be covered by another membrane. 
A most valuable agent for hastening its removal is peroxide of 
hydrogen. It should be sprayed into the throat with an atomizer 
every twenty minutes for three times. The following mixture 
should then be used: Oil of sweet almonds one ounce, oil of 
eucalyptus five drops, and menthol from five to fifteen grains ; 
spray it into the throat once an hour, or as often as the throat 
becomes dry and painful. Inhaling steam from water, or from 
water and cider vinegar, as hot as can be taken, by means of a 
rubber tube attached to the spout of a teakettle, is good to afford 
temporary relief, but, aside from this, is of little value, and, if long 
used, or often repeated, is liable to do harm. Never use poultices 
in treating this disease. 

In some cases where the diphtheritic membrane is large the 
patient can be saved from smothering by intubation, which con- 
sists of inserting a silver tube, designed for the purpose, into the 
throat and leaving it there until the membrane loosens and can 
be removed. Sometimes this fails because of the formation of 
another membrane in the trachea below the end of the tube, but 
the device has saved many lives. 

The Antitoxin Treatment . — There has been a wide differ- 
ence of opinion among physicians as to the value of antitoxin, but 
the treatment seems to have promptly reduced the death rate of 
this disease in Parisian hospitals to one-half that prevailing before 
its introduction there, and about the same reduction through its 
use is reported in Germany, but, if statistics can be relied upon, far 
more beneficent results have been obtained in this country. 



282 GENERAL DISEASES. 

"Prior to the introduction of antitoxin, the mortality rate in 
Chicago was about 35 per cent, and in the first twenty-six months 
of its use by the health department of that city the rate was reduced 
to 6.77 per cent, but the results recorded for November last are 
nothing short of marvelous. During that month 163 cases were 
reported and investigated, 98 of which were found to be true 
diphtheria, and were treated with antitoxin. In addition there 
were four cases remaining from the previous month, so that in all 
102 cases were treated, from which there were 97 recoveries, 3 
deaths, and 2 remaining under treatment at the end of the month, 
making the extremely low death rate of 3 per cent. These facts 
should remove any remaining scruples which may exist against this 
treatment. ,, — -Med. Record. 

Diphtheria antitoxin is the serum of an animal's blood, usu- 
ally that of a horse or goat, rendered immune by a large number 
of inoculations with diphtheritic virus. The following is substan- 
tially the process, as given by E. Roux of Paris : A healthy horse 
is given at first a hypodermic injection of 15^ drops of strong 
diphtheritic virus prepared by culture. As soon as the resulting 
fever subsides he is again inoculated, but with a larger amount. 

This is repeated again and again, the amount injected being 
each time increased. At the end of the first month from twenty to 
thirty times as much virus is used as at first, without increasing 
the symptoms. The inoculations are thus continued a great many 
times until very large amounts of the most virulent diphtheritic 
poison can be injected directly into his veins without causing more 
than a fleeting rise of temperature. This requires from three 
months to two years, and the horse is then said to be immune 
and the serum of his blood is ready for the treatment of patients. 

It is usually injected under the skin of the thigh, and the aver- 
age amount used at first is about one one-thousandth the weight 
of the patient. 

It is expected that within twenty-four hours after the injec- 
tion the diphtheritic membrane will cease to form and that it will 
become detached from the throat in from thirty-six to seventy-two 
hours. Intubation is the complement of the treatment, enabling 
the patient to breathe until the membrane can be removed. 

Diphtheritic germs are often found in the throat of a patient 
many days after all signs of the disease have disappeared, hence 
he should remain in quarantine until from^examination he has been 



GEXERAL DISEASES. 283 

found free from the contagion. Each day his sputa and the soiled 
cloths used about him should be burned and all his dejections dis- 
infected. 

As a preventive measure in suspected cases of diphtheria, the 
throat should be dusted twice a day for three clays with equal parts 
of quinine and flour sulphur. In a small glass tube, six inches or 
more in length, place the mixed powder, then blow it into the 
throat, using the precaution of placing the tube in boiling water 
immediately afterward. 

Having had diphtheria is no protection against having it 
again, on the contrary it seems to predispose the patient and 
render him more liable to the disease. Recurrences sometimes 
are separated only by short intervals, and there is considerable 
danger in placing patients that are convalescent from it in close 
contact with new cases of the same disease. 

MEMBRANOUS CROUP. 

Except in degree of severity there is no difference between 
membranous croup and diphtheria. Both are caused by the same 
germ, but croupous inflammation involves only the superficial or 
epithelial layer of the mucous membrane of the throat and is com- 
paratively mild, while diphtheria extends to the deeper layers of 
the membrane and is the severe form of the disease. The treat- 
ment is identically the same for both. 

VARIOLA. 
(Small-pox.) 

Small-pox is such an old disease that its original habitat is 
uncertain, but it is known to have been epidemic in China many 
centuries before Christ, and that it was introduced into America 
by the Spaniards shortly after the discovery of the New World. 

The germ to which it is due has not been found, but the 
virus, or poison, produced by it is of such virulence as to make 
small-pox the most infectious, malignant and fatal of all diseases. 
It is supposed that it usually makes its entrance into the system 
by way of the lungs, being inhaled with the breath. It is also con- 
tagious, but in this case the virus must reach the blood through a 
wound, for contact alone is not enough. The eruptive matter, 
though taken fresh from a small-pox pustule and reeking with 
the septic poison, will not convey the disease by being merely 
smeared upon the unbroken skin. 



284 GENERAL DISEASES. 

The disease, when introduced through a wound or abrasion, 
has the singular property of running its entire course with less than 
a hundredth part of the malignancy and danger that accompanies 
it when, as infection, it is taken into the system through the 
breath — a phenomenon which has never been explained, but of 
which practical advantage has been taken in India and China for 
many centuries, and from which countries the system now known 
as inoculation spread to other lands and became almost universally 
employed by all civilized nations. 

As people of both sexes and all ages of every race and climate 
are subject to this disease, rarely failing to take it at the first 
exposure, and as it was usually fatal in one-third of all the cases 
contracted through infection, and of the other two-thirds a very 
large proportion were disfigured, maimed or disabled for life ; 
and as it is variously estimated that only one case in every 
three hundred to ten hundred cases from inoculation is fatal, and 
the disease from this source is as sure to cause immunity from 
further attacks, as an attack brought on by infection, it is at once 
seen that the value of this discovery was beyond comprehension. 

Authorities differ as to the time at which a small-pox patient 
will first give the disease, some affirming that this danger is not 
reached until the eruption begins, while others maintain that the 
poison constituting the infection exists in the breath and exhala- 
tions of the body, as well as in the eruptive matter of the pustules, 
that the clanger commences even before the first symptoms appear, 
reaches its height during the period of desiccation (drying of 
scabs), and continues until sometime after the eruption disappears. 

There is also a wide difference of views as to the distance to 
which the infection may extend, some claiming that it may be dis- 
seminated over a whole city, others denying that there is any dan- 
ger further than from three to six feet from the patient, if he be 
in the open air. Both of these theories may contain some grains 
of truth, for the distance must vary greatly in different stages of 
the attack. As drying does not destroy the germs, the dried scales, 
as a dust-like powder, are the most-to-be-dreaded medium of 
spreading the disease, for the germs upon them, retaining their 
virulence indefinitely, may settle upon everything in the room or 
be borne considerable distances by favoring breezes. Of course, 
they may also be carried in clothing hundreds of miles, and there 
is always very great danger from clothing and bedding used by 



GENERAL DISEASES. 285 

patients with this disease. If laid away it may continue to be a 
menace for many years. Open air and bright sunshine, especially 
the latter, are good disinfectants and exposure to them greatly 
diminishes the danger, but the only safe way is to immediately burn 
all clothing and furnishings used about the patient as soon as he 
recovers. 

The mildest case of small-pox may impart the disease in the 
most malignant form, for the degree of severity depends upon the 
constitutional condition of the patient. Although one attack usu- 
ally confers immunity there have been a few people who have had 
a second attack, and a very few who have had small-pox for even 
the fifth or sixth time, and, strangely enough, the last attack, in 
some cases, was severer than the first. On the other hand, there 
is said to be, once in a great while, a person who is insusceptible 
to the disease and does not take it, no matter how often exposed. 

The dark-skinned races, especially the negro and Indian, 
suffer most from small-pox, whole tribes of the latter having been 
swept out of existence by it in a few months, but the Mexicans 
seem to be an exception to this rule, for, although the disease is 
very common anion sr them, and, anionic their lower classes, is 
spread chiefly by infection, the advantages of inoculation not 
being understood by them, there is not an unusually large per- 
centage of mortality, and often the attack is so light that the patient 
hardly "lies by for repairs." 

Symptoms. — By many writers the course of this disease, from 
exposure to recovery, is divided into stages, each of which merges 
almost imperceptibly into the next. 

(i) The Stage of Incubation, or the time from exposure or 
inoculation until the first symptoms appear. This interval in 
cases from inoculation consists of about seven days, but cases 
from infection proceed so much more slowly that the first symp- 
toms do not usually appear until the twelfth day, rarely a day or 
two earlier or later, but never later than the fifteenth day. 

(2) The Stage of Invasion. — In children the attack usually 
begins with convulsions, in adults with a sudden severe chill, fol- 
lowed by fever that increases so in intensity that a temperature of 
105 degrees to 106 degrees may be reached by the time the erup- 
tion appears, which is usually on the third day. Many 
constitutional disturbances accompany the fever and, like 
it, increase in severity until the eruption appears. They 



286 GENERAL DISEASES. 

consist of fullness, or pain in the abdomen, nausea, 
vomiting (often severe and obstinate), pain throughout the 
entire body, but especially in the middle and lower parts of the 
back, trembling, such weakness that the patient can hardly stand, 
and a sense of severe illness. There is generally intense headache, 
the face is flushed and the great arteries of the neck throb violently, 
with the pulse from 120 to 160 per minute; but sometimes the 
face is sunken 'and pale, and the extremities cold. There is great 
thirst, the tongue and lips are dry and parched and the tongue is 
likely to be thickly furred ; there is no appetite and constipation is 
usually prominent throughout the entire course of the disease, but 
there may be diarrhea instead. 

In two, days there are likely to be inflamed and swollen tonsils, 
sore throat, hoarseness, and sometimes a condition resembling: 
catarrh. Occasionally there are nervous symptoms at the begin- 
ning, such as restlessness, delirium, drowsiness, stupor and coma. 
Convulsions are frequent in children, and sometimes occur in 
adults. The intensity of the symptoms during this stage does not 
always indicate the severity of the succeeding stages, and the diag- 
nosis cannot always be positive until this stage has passed. 

(3) The Stage of Eruption. — The eruption begins upon the 
face, especially the forehead, and upon the scalp and neck, and, as 
already stated, usually first appears the third day, but may come 
on the second, or may not arrive until the fourth. It may be so 
copious that the minute red spots almost cover the skin, in which 
case, at this time, it is liable to be mistaken for measles, but in one 
or two days the papules of the eruption spread over the entire 
body, though not as thickly as upon the face. They may be 
separate or may run together. The eruption may appear at the 
same time upon the mucous membranes, and the saliva be greatly 
increased. 

(4) The Stage of Suppuration begins in from six to eight 
days after the appearance of the eruption, is characterized by the 
maturing of the pustules and the discharge of their contents, and 
is the most dangerous period of the disease. More deaths occur 
on the eleventh day than any other, but from the eighth until the 
thirteenth day there is very great peril, especially if the eruption is 
very copious, in which case one pustule is likely to run into another 
until the entire face is covered with a mass of corruption. The 
evelids may be swollen shut and the features so disfigured as to 



GEXERAL DISEASES. 287 

be unrecognizable. The feet, hands and genital organs may be 
affected in the same way and fearfully distorted. 

The primary fever probably subsided as the eruption pro- 
gressed, but now the secondary or suppurative fever begins, and 
frequently reaches a greater height than the first. It is usually 
ushered m by a chill, and, although intermittent in type and at its 
worst in the evening, increases in intensity until the suppuration 
reaches its height, then gradually declines as desiccation advances. 

(5) The Stage of Desiccation (drying period) begins about 
the twelfth day and lasts from one to two weeks. The pus and 
fluids from the pustules dry and harden into scabs or crusts which. 
in severe cases, may cover the whole face like a mask. Gradually 
the scabs loosen and come off, the process being attended by the 
most uncomfortable itching. 

Roberts thus describes a typical pock : "It starts as a bright 
red spot a little raised; enlarging and becoming more elevated, it 
forms a distinct papule on the second or third day, circular, well 
defined, flattened on top and having a peculiar solid, hard, dense 
feel, compared to that of shot or mustard seed under the skin. 
This soon changes into a vesicle, a little clear, thin fluid collecting 
in the center under the epidermis. 

"About the fifth clay a depression forms on the top of the pock. 
At the same time the contents gradually assume a purulent char- 
acter. This change begins at the circumference, the central part 
still for some time remaining vesicular, and separated from the 
surrounding pus by a transverse partition, so that either part can 
be emptied of its contents without disturbing the contents of the 
other part. At this time a distinct ring of inflammatory redness 
appears around each pock, the pus increases and after a while the 
depression disappears, the pock becoming either globular or 
pointed at the top, while the color changes to yellow. 

"About the eighth clay the pustule is at its height, having 
arrived at the end of the stage of maturation. It then undergoes 
retrograde changes and within the next two or three days either 
bursts, its contents discharging and drying up, thus forming 
a yellowish-brown scab, or it shrivels and dries up without ruptur- 
ing. In from eleven to fourteen days the scab usually separates, 
leaving a reddish-brown stain, which remains for a variable period. 
Sometimes the scabs remain adherent a long time, especially about 
the nose and on the scalp. When they fall off the body generally 



288 GENERAL DISEASES. 

there is a fine, dusty scaling of the skin and where its deeper layers 
are all destroyed a pit is left which finally becomes of a dead white 
color. The course of the eruption is greatly modified by the vari- 
ous circumstances peculiar to each case. The skin between the 
pocks is usually of a deep red color and feels sore and tender, and 
there is nearly always such intense itching that the patient can 
hardly refrain from scratching, although this aggravates the sore- 
ness and adds greatly to the final disfigurement." 

Treatment. — The patient should be confined in a single room 
and be kept quiet in bed. His room should be large, light and 
well ventilated, without exposing him to drafts, and its tem- 
perature should be kept as nearly as possible at from 60 degrees to 
65 degrees. » Carpets, curtains, surplus bedding and all other furni- 
ture that can be spared should be removed at the very beginning. 
All surroundings and conditions must be made as healthful as 
possible. Cleanliness is of very great importance. The room, 
patient, clothing and bedding must all be kept clean. The linen 
should be changed often, and that removed should be plunged 
immediately into hot water and kept boiling for thirty minutes to 
secure thorough disinfection.. 

Begin with a scant diet of easily digestible food, giving fruits, 
especially baked apples, a prominent place. A little later the diet 
should be gradually increased, as by the addition of soups, beef tea, 
beef juice, jellies, etc., and care taken to furnish sufficient nourish- 
ment to keep up the strength of the patient, especially when a 
copious eruption or other severe symptoms give warning that the 
struggle is to be long and hard. The suppurative stage is the most 
trying one, and the early management must be such that the 
patient shall reach it in the best possible condition. The best drink 
is cold water and the patient should have all that he wants of it, 
but lemonade, milk and mucilaginous drinks are permissible. 
Stimulants of all kinds are to be prohibited at this time. 

The fever is best controlled by giving from three to five grains 
of quinine once in four hours, and by sponging the face, hands 
and body in water as hot as can be borne, since opening the pores 
facilitates the escape of heat and poisonous exhalations. Sponging 
at this time is better than immersion baths. 

For the headache apply ice compresses or ice bags to the head. 

For sore throat hold bits of ice in the mouth, apply ice com- 
presses to the throat, and use a gargle of one part of listerine to 
seven parts of water every hour. 



GENERAL DISEASES. 289 

For vomiting hold ice in the mouth ; in some cases sipping 
hot water and applying a hot fomentation to the stomach will be 
found to serve the purpose better, and sometimes a Seidlitz powder 
will give relief. 

For constipation saline laxatives should be used to secure 
a free movement every day, for which purpose a teaspoonful of 
granular effervescing phosphate of soda is a good remedy. 

For diarrhea give from twenty to twenty-five grains of sub- 
nitrate of bismuth every three hours ; should this not prove effect- 
ual add to the dose two grains of tannic acid ; or, if the case be 
very urgent, give with the bismuth from five to fifteen drops of 
the tincture of opium. 

For hemorrhage give three grains either of tannic acid or 
gallic acid every four hours, or fifteen drops of the fluid extract 
of ergot every three hours until the bleeding is stopped. 

If nervous disturbances appear, three-grain doses of Dover's 
powder may be given every three hours until they are controlled. 
A warm bath often soothes the patient and induces sleep. If these 
measures are not successful, trional in doses of from fifteen to 
twenty-five grains should be given every four hours until sleep is 
obtained. 

The urine should be drawn with a catheter, if retained beyond 
a reasonable time. 

When the eruption appears especial attention should be given 
the eyes. 

They should be protected from bright light by a green shade 
and bathed very often in a warm solution, composed of one grain 
of corrosive sublimate and four ounces of water, but it must be 
remembered that this remedy is a poison. 

To prevent pitting and disfigurement, use has often been 
made, during the suppurative stage, of such devices as nitrate of 
silver, carbolic acid, opening each pustule as soon as it contains 
any pus, keeping the patient in a dark room, etc., but none of them 
has proved successful. Nothing can prevent scars if there is much 
destruction of the lower layers of the skin. 

The better course is to apply ice compresses to the face, for 
although they may not so control the eruption as to make it less 
copious, they reduce the swelling and inflammation and, to some 
extent, prevent destruction of the skin tissues, besides greatly re- 
lieving the patient. Anointing the rest of the body with olive oil, 

19 



290 GENERAL DISEASES. 

containing one-tenth its volume of carbolic acid, serves a good 
purpose and during the drying-up stage is especially valuable. 

During suppuration much care must be exercised to keep up 
the strength by plenty of good, easily digestible food, and stimu- 
lants should be administered if there is great weakness or signs of 
collapse. Cod liver oil is often used with excellent results at this 
time. 

The secondary fever should be treated in the same way as al- 
ready outlined for the primary fever. 

When the stage of desiccation arrives, a warm bath each day 
will not only be very grateful to the patient, but will assist in re- 
moving the scabs ; the body should then be thoroughly dried with 
soft towels and anointed with the carbolized oil to prevent itching 
and assist the-healing process. It will also do much to suppress the 
offensive odor often present in this disease. As disfigurement 
is greatly increased by scratching, the patient must refrain from it 
as far as possible. The scabs should be left until they dry and are 
rubbed off. The face may then be painted with the tincture of 
iodine to prevent warty nodules, but nothing will prevent scars if 
the lower layers of the skin have been destroyed. 

Not until the patient has taken five or six baths at intervals of 
two days each, after all the scabs have disappeared, and has spent 
considerable time in the open air, should he be allowed to resume 
his place in the family or mingle with other people. 

All bedding and furniture contained in the sick-room should 
be very carefully disinfected or, better still, burned ; and until 
the room has passed through a most thorough course of disinfec- 
tion no one, not immune to the disease, should be allowed to en- 
ter it. The nurse and physician, while attending a case of small- 
pox, should never meet other people without having first care- 
fully bathed and cleansed themselves, dressed in clean clothing, 
and taken a thorough airing. 

There is no way of aborting small-pox after it has begun. 
No intelligent person any longer thinks of attempting to modify 
it by sweating, vomiting, purging or bleeding. . 

VACCINIA. 

(Cow-pox.) 

As already shown, the discovery that small-pox can be robbed 
of its chief terrors by inoculation was of priceless value to the 



GEXERAL DISEASES. 291 

human race, but it had this very grave defect : The contagion of 
the disease thus induced is as virulent and dangerous to other 
people as any other case of small-pox. It remained for Jenner, an 
English physician in 1798, to bring to the attention of the scientific 
world the curious fact, which for some time had been known and 
practiced by his townsmen, that cow-pox introduced into the hu- 
man system by inoculation, now called vaccination, renders it 
for a time, at least, almost immune, and, in a large majority of 
cases, after thorough and satisfactory revaccination, constitutes 
an absolute protection against small-pox, and when it does not en- 
tirely prevent the disease, almost always so modifies it that it is 
attended by little if any danger. 

Cow-pox, or vaccinia, is an acute disease caused by a specific 
virus and occurs naturally in the cow, but is seen in people only 
as a result of inoculation with lymph (virus), taken from the cow 
or from individuals previously inoculated. The contagion is by 
some believed to consist of germs belonging to the class known 
as micrococci, because they are always present in the lymph and 
since filtration of lymph destroys its virulence. Certain investiga- 
tors also claim to have propagated these germs in substances pre- 
pared for the purpose, and from these artificial cultures to have 
successfully practiced vaccination: still it is not certain that the 
disease is due to these cocci rather than to another germ that has 
thus far eluded detection. 

As skin diseases, scrofula, syphilis and the like, may be trans- 
mitted by vaccination from one person to another, too great care 
cannot be taken to secure healthy lymph, and although lymph 
taken on the eighth day from the vesicles of a patient is quite as 
efficient as animal lymph, the latter is much to be preferred be- 
cause of the greater certainty of its being free from such contami- 
nations. There is no danger in using the lymph obtained at prop- 
erly managed vaccine farms from inoculating healthy heifers. It 
is usually preserved on bone or ivory points, and kept on sale at the 
drugstores. 

Unless at a time of great danger from small-pox infection, a 
child should not be vaccinated unless in good health and until it is 
from six to twelve weeks old. The outside of the arm, midway 
between the shoulder and elbow, is the place generally selected for 
the insertion of the lymph, but for girl babies many careful moth- 
ers prefer to have it placed in one of the lower limbs, because of 



292 GENERAL DISEASES. 

the ugly scar it causes. The skin should be cleansed and drawn 
tightly and a place a half-inch square scarified by cutting many 
parallel and cross lines with a lancet or sharp pointed knife just 
deep enough to scarcely start the blood, then dip the vaccine 
point in water and thoroughly rub its charged sides upon the 
scarified surface, and when it has dried protect it with a little cot- 
ton-batting, or soft cloth. If there is any erysipelas or suppura- 
tion in the house keep the place of inoculation protected by cover- 
ing it with a pad of antiseptic cotton. 

Soreness begins in two or three days and about the eighth 
day the vesicles reach their most perfect stage, but the swelling 
may continue two or three days longer. There is more or less 
hardness and sense of tightness of the skin, itching, heat, pain 
and stiffness, and during maturation there may be fever, sometimes 
reaching 104 degrees. In about three weeks the scab which has 
formed falls off, leaving a permanent scar. If the first vaccination 
fails or is only partially successful there should be revaccination in 
a few days, and it is necessary to revaccinate after puberty, no 
matter how perfect the vaccination may have been in early child- 
hood. If this revaccination is thoroughly successful it is thought 
by many to be sufficient for the remainder of life, but vaccination 
is not an invariably permanent preventive, and a person exposed 
to small-pox should be immediately vaccinated, whether he has 
ever been vaccinated before or not, for the stage of incubation in 
cow-pox is shorter than that of small-pox and the severer disease 
may thus be averted. When small-pox has begun vaccination will 
in no way modify its course. There is a much smaller proportion 
of deaths from this disease in persons in whom the effects of a 
single vaccination have so far worn out as to render them no 
longer immune, than there is in people who have never had any 
protection. Vaccination may lead to blood poisoning and ery- 
sipelas, but these cases are extremely rare. 

Treatment.' — It usually is necessary only to protect the arm 
from irritation. The vesicles must not be scratched and the scab 
should be left until it falls off. In case of much inflammation the 
part should be covered with wet lint, cream or powdered starch. 
During the fever the child should be kept in the house and given 
a mild laxative, as a teaspoonful of castor oil or Epsom salts, as 
occasion may require. If unusual complications arise they must 
be specially treated. 



GEXERAL DISEASES. 29b 

YELLOW FEVER. 

Yellow fever is an acute, specific, highly infectioas disease, oc- 
curring chiefly 'in epidemics within certain geographical limits in 
tropical or subtropical countries. Although skillful scientists have 
long looked for the micro-organism which produces it, and sev- 
eral have at different times announced its discovery, no one has 
yet succeeded in isolating a germ that has been found in over fifty- 
six per cent of the cases investigated, including even post-mortem 
examinations, nor in finding one that by inoculation produces 
symptoms in animals sufficiently like those of yellow fever to 
warrant the conclusion that they are those of the disease itself, or 
of a modified form of it. So good an authority as Guiteras says : 
"As far as our present methods go, it is impossible to distinguish 
between a drop of yellow fever blood, and blood from a healthy 
man." Yet no intelligent person any longer doubts that yellow 
fever is a germ disease, for its phenomena can be explained upon 
no other theory. 

Bad sanitary conditions will not produce the disease, de novo, 
but they furnish excellent soil for its propagation, for when once 
introduced the infection increases with great rapidity in decaying 
matter and all kinds of filth. The germs are transmitted through 
the air and may enter the lungs through the breath, and thence 
find their way into the blood, or they may enter the system upon 
contaminated food, but it is probable that the usual mode of in- 
fection is by their settling upon the lips or being drawn into the 
mouth, and finding their way in the saliva to the stomach, thence 
to the upper portion of the small intestine, which is their favorite 
habitat, and, rapidly multiplying, produce the poison that by ab- 
sorption gives rise to the disease. One attack, however light, ren- 
ders the patient immune ever afterward. Natives of yellow fever 
countries are less susceptible than immigrants, and negroes are 
less liable than whites, and, when they do take the disease, have 
it in milder form. The time from exposure to the appearance of 
the first symptoms varies greatly, ranging from one to ten days. 

The following treatment for yellow fever is given by Surgeon 
R. D. Murray in the report prepared for 1898 under the direction 
of the Supervising Surgeon-General Marine Hospital Service of 
the United States : 

I have seen yellow fever in twenty-one summers and in every 
month, except February. The elimination of yellow fever from 



294 GENERAL DISEASES. 

our nomenclature will follow when there is a proper conception of 
the influence of clothing, bedding and unclean bedrooms as trans- 
mitters. The disease is borne for some distance; the infection is 
stronger at sometimes and places than at others; whether it is in- 
tensity or quantity I do not know ; it may be diluted, and is trans- 
mitted by clothing", bedding and related articles. Hair from the 
dead has transmitted it; corn sacks, blankets and old newspapers 
have carried it ; mountains of filth will not produce it ; but they 
may give it a new nidus or garden from which it goes out "seeking 
whom it may devour." The cleanest town in the South may have 
a severe prevalence if the people insist on disobeying the advice of 
the health officials. 

In 1875, as a result of several post-mortems and an attack 
of the disease, I came to the conclusion that yellow fever is 
primarily an inflammation of the duodenum. Many post-mortem 
examinations have since convinced me that the primary lesion is 
in the duodenum, and I insist that the mildest cases have a lesion 
in that organ which can be demonstrated, if due care be taken. 
The same after-death examinations, as well as bedside experience, 
have shown that the death-dealing process is not the "inflam- 
mation" that I was taught thirty years ago to understand as in- 
flammation, i. e., there is no proliferation of cells or tissue, and no 
new growth. 

There is a primary involvement of the duodenum and the 
symptoms of the disease generally follow in regular order. The 
mildest cases have a tender duodenum — if you know how to press 
— and a little backache (note how close to the spinal column the 
duodendum lies.) If the stools could all be examined, sometime a 
mass of white mucus with a black or brownish middle would be 
found. Perhaps there would be a stool of black mucus only once; 
but it is fair to say there is always a clay or bismuth stool with the 
mucous clot stained with black. In bad cases the upper intestine 
and stomach are also involved. 

Sometimes the symptoms come in such quick succession 
that we think the attack is necessarily fatal. Many times in such 
cases Ave have no chance to ask the patient how matters fared 
with him twenty-four or thirty-six hours before, when he was sick, 
but would not admit it. Walking cases are as common in this as in 
other bed diseases. I have known a man, suffering with head- 
ache, to remain on duty three days, then vomit black on the stairs 



GEXERAL DISEASES. 295 

on the way to his death bed. I have given immune certificates to 
persons who did not go to bed at all. 

In ordinary, the patient should like the medical attendant. If 
the physician is distrusted, he should be called out, that a favored 
one may step in. Consultations over a patient are injurious. I 
would have the doctor do his share in keeping up courage, hope 
and life-purpose in his patient ; to minimize the aches, distress and 
fears, and to carry the patient's mind away from the now with 
its dreads to to-morrow, with its rewards or revenges. Several 
people are living now 7 because, in their desire to take vengeance 
on me for what they thought was my indifference, they forgot 
themselves and their condition. 

Not every case needs treatment. 

Of one hundred cases, seventy-five need only to be let alone, 
both by physician and nurse. They will get well under any plan 
of treatment and under miserable local conditions ; notably so of 
infants, who, if they die, are generally sacrificed by curds or some 
acrid medication. These seventy-five are "cases" and should be 
recorded, but only for the sake of good records and to establish 
their immunity. They should receive only what occasion de- 
mands and be watched for untoward incidents. Of the other twen- 
ty-five, some will need formal attention and careful procedure; 
others will die in spite of all reasonable aid. Some vicious habit or 
chronic disease will add to the trouble, and in some cases uncon- 
trollable fear will insure a fatal result. 

My oldest patient to get well was 109 years of age ; the young- 
est was 52 hours old when she threw up black vomit. One of my 
children had black vomiting five days after she was born. I know 
of the recovery of a chronic B right's disease sufferer; of a mor- 
phiomaniac's recovery, and I last summer gave a diabetic doctor 
such cheerful counsel that he had a severe attack without fatal 
result, and has been in better health since than before. These 
cases show r the triviality of the disease if taken in time. Yellow 
fever is the most honest, most trivial and cheapest to treat of all 
diseases that kill. It is honest because it comes with definite 
signs and leaves no trace, always assuring the afflicted one that 
ever after he will be immune ; it kills, if at all, in a few days, and 
is merciful in the killing, as the doomed one is conscious to the 
last and does not linger, as a consumptive or victim of cancer ; 
trivial, because fifty per cent of the cases are scarcely aware of 



296 GENERAL DISEASES. 

serious illness, and have no sequels to make them miserable the 
rest of their lives ; also because it rarely takes off children, and by 
reason of the attack they gain the privilege of living in its habitat ; 
cheapest to treat, because it is so, the medicine needed costing very 
little. 

Treatment. — When called to a man who has had a chill some- 
time during the previous night, has a pulse of ioo to 112, with 
temperature of 101.5 degrees to 103 degrees, headache (cutting 
across the forehead), backache running down into the thighs, sore 
muscles, skin hot if you hold your hand on it a while (hands and 
wrists not hot to gentle touch), loss of appetite, white tongue 
(may be a yellow center far back ; the red edges and red diamond 
on tip will not show at once), suffused eyes and notably or faintly 
purpled cheek bones with half-puffed upper lip, the hundred 
chances are you have a case of yellow fever. Yellow fever usually 
begins at night when the person is in bed and in a relaxed condi- 
tion ; malarial fever usually attacks when the patient is at work. 
Night watchmen have sickened in daytime. A restless early morn- 
ing in bed, with little desire for breakfast, is a frequent history; 
everything eaten at breakfast does harm in such cases. Dengue 
pains are w T orst in joints ; yellow fever soreness is between' the 
joints. As to malarial coincidents, there is no rule for differentia- 
tion excepting, perhaps, the attack in bed or at work. 

Give three or four compound cathartic pills at once, and as 
soon as possible give a hot foot bath with or without mustard 
and salt. An all-over bath is better, but is not always possible. 
Mustard at this time is really non-essential, but sometimes the 
patient thinks it is the proper thing ; so with table salt. As to the 
cathartic, calomel at first is too slow and usually must be sent 
for; the pills contain enough of it and are in your vest pocket. 
Everv yellow fever doctor should carry : First, doses of compound 
cathartic ; next, compound acetanilide tablets ; then, such other 
pocket remedies as may be needed on emergency. The parade of 
a small medicine chest is not advised. Do not begin to make a 
reputation for wonderful medical skill now. Dwell on the dengue 
symptoms and the signs of malaria, and without great formality 
convince your patient that "it is not yellow," but do not say so. 
Keep back information as to the actual temperature all the way 
through. No patient should ever hear that his temperature went 
above 102 degrees until after he gets well. (I saved a doctor once 



GENERAL DISEASES. 297 

by hiding his thermometer and using my French scale, which he 
could not translate.) 

Give as soon as convenient, or, if fever is above 102 degrees, at 
once, any coal tar derivative in seven and a half grain doses, with 
some bicarbonate of soda and caffeine. The antikamnia compound 
is a good one. If powders or tablets are objectionable to the 
patient, give antipyrine. I nearly always use acetanilide with soda 
and caffeine. Have no objection to any, except that I like cheap- 
ness and simplicity. After the bath and a good sweating, under 
blankets, for from four to six hours, rub dry and cover with two 
blankets. (The clothing should have been hung outside the house 
or dumped into a tub of water; dispose of the wet sheets and 
blankets in like manner. When washed and boiled they are ready 
for use again ; this hint in regard to prevention of infection.) If 
a person likes blankets next the skin they are better for prevention 
of skin shock. Quilts and counterpanes are objectionable because 
of the nasty odors they retain. 

Repeat the coal tar derivative every three to six hours if fever 
keeps above 102 degrees; give for effect and not pro forma. Have 
the face and hands wiped frequently, give orange-leaf tea, Apol- 
linaris water, lemon-grass tea, hot lemonade, ginger ale, small sips 
of ice water, and other drinks ad libitum, but not ad nauseam. 
Always start with the quantity you are willing the patient should 
have, and let him drain the cup ; this particularly in the case of 
water. Try to supply fluid for the three or four days' sweating 
that will be kept up. Apollinaris is good on account of the com- 
mon salt it contains ; for some reason common salt is a good thing 
to give and has been grossly neglected. Passed Assistant Sur- 
geon Smith, on duty at Ship Island last year, used it, methodically, 
about a dram a day, with excellent results. I have always given 
much salt in the food, but never gave it dry. No spirits of any 
combination should be even thought of for the patient. 

The first bowel actions should be while sitting up for the first 
thirty-six hours or so for physical reasons, and for mental reasons, 
too. If the bowels are not freely and completely relieved within 
six hours, give a small saline and let the patient choose the kind. 
Castor oil is the best thing to give, but many so bitterly object 
to it that it is not advisable in all cases. Sulphate of soda is the 
next best. As a rule, the magnesias cause griping and flatulence. 
Seidlitz powders are good, but cause some gas and uneasiness — 



298 GENERAL DISEASES. 

however, the patient should have his choice, as he feels bad at this 
time and an insistence on one thing magnifies his dangers, in his 
own mind. Sometimes an extra pill w 7 ill do the hoped-for duty. 
I do not object to syrup of figs, castoria, or other cathartics — only 
want results. If nausea is present an enema is in order. 

Diet, or Lack of It, a Matter of First Importance. 

Do not deny food, but give the milk-like water of long boiled 
hominy or corn meal, salted and strained through cheese cloth. 
Keep the pot boiling all the time. Rice water is good ; sago is 
better, as it is slightly aromatic, but my experience has been with 
the poor. Mexican atole is excellent, made from crushed lye- 
hominy. Sometimes it is well to flavor with a bit of meat juice. 
Chicken soup, with rice, so thin as to be equal to starch water, is 
not to be tabooed. The point is to give no food for four or five 
days, but to appear to give food regularly. Often, you must 
promise food and abuse the nurse in the presence of the patient for 
the non-fulfillment of your orders, then apologize to the nurse out- 
side. 

If the first fever remedy tires the patient, or seems to do him 
no good, change the form ; here lactophenin or amonol or anti- 
pyrine will serve as substitutes ; maybe capsules of the same as 
you were giving will accomplish the object sought. Do not for- 
get the bicarbonate of soda and caffeine. Remember always that 
the patient is sick ; not the doctor. 

Here I must advise you to carefully consider the question of 
malaria, for the Laveran organisms can do their work while the 
yellow fever germ is also active. In a malarial region it is advisable 
to give from forty to sixty grains of a cinchona salt in the first 
twelve to twenty-tour hours, in order to ward oft or forefend a 
malarial chill, which might occur during the period that should 
be yellow fever convalescence. I lost two patients from malaria, 
twenty years ago, when they were convalescing from yellow fever. 
In non-malarious regions, or on shipboard, no such caution is nec- 
essary, but in Mobile, New Orleans, Scranton, or the back country, 
care must be exercised. The preliminary cinchonidia or quinine 
may be given with the compound cathartic pills, and it is believed 
that early cinchona aids in producing calm in or to the patient. 
Do not give all at once, and do not expect the cinchona salt to 
act instead of the coal tar products. Give them together, or 
nearly so. 



GENERAL DISEASES. 299 

After thirty-six hours or so give an enema every day and 
try to have a bed-pan used. It is impossible for some to use a bed- 
pan; in which cases have the patient helped up on a vessel or 
commode. Instruct the attendant that the patient must be helped, 
and not allowed to use his own strength ; his muscular force must 
be saved. If the expected does not occur, give another enema with 
a long tube. A short catheter of thirty or thirty-two caliber should 
be in every yellow fever doctor's pocket, which, attached to an 
ordinary self-injecting syringe, makes a long tube. The large 
catheter has saved many lives ; it may be washed and used again ; 
do not fear infection. 

Enemas may be made most quickly with soapsuds and mo- 
lasses ; ordinarily soapsuds will suffice, later on not too strong. 
Consider the stools and if they are not sufficient in quantity, and 
you have reason to believe there is a fecal matter high up, give a 
dose of castor oil, two drams, and olive (not lard) oil,' six 
drams, more or less as occasion seems to demand. Lemon juice 
is the best vehicle for the oil. Perhaps it will be best to tell the at- 
tendant to give the potion as if you knew nothing about it. Pa- 
tients like to circumvent the doctor! I believe that small doses of 
castor oil and large doses of sweet oil will not produce the fre- 
quent contractions of the colon and the common intussusceptions 
of the small intestines that are found post mortem. Constant 
peristalsis downward is necessary ; harsh purgation is to be avoided. 
This remark does not refer to the primary emptying of the bowel. 
but to repeated emptying efforts by calomel or pills or salts to in- 
sure a daily bowel movement. Olive oil does not cause the bowel 
strictures that I dread — I think small doses of castor oil will not. 
I prefer to mix them and have saved many lives by this plan. 

For nausea use ice about the head, face and neck. A piece of 
ice in a cloth, rubbed rapidly about the lips, temples and neck, will 
keep down almost any offensive close. If the nurse cannot do it 
effectively, or does it rudely, do it yourself. Give cocaine in one- 
fourth grain tablets floated down the throat, repeating as required ; 
solutions do not accomplish the object as well and as patients are 
human beings they might be poisoned. Dr. Thorington of Colon 
introduced cocaine as a remedy in yellow fever nausea, in doses of 
two to three grains in solution. I think that I was the first to 
insist on small doses in tablet form floated into the stomach, where 
it is needed. Bathing the face frequently with vinegar is excellent 



300 GENERAL DISEASES. 

to subdue nausea. Eau sedatif is praiseworthy for the vinegar 
it contains. Elegant toilet waters are pleasing to all and possible 
to some. Mustard to the upper part of the abdomen is always to 
be resorted to, but avoid sickening the patient by putting the 
pungent mass too near to his nose. Look to the covering, the pil- 
low, the mattress, the commode, the nurse's breath, or other con- 
dition, as a cause of nausea. A fresh sheet, or pillow case, or pil- 
low sometimes makes a "lot of difference" in the matter of com- 
fort. Do not forget the bowel peristalsis; the '"duodenal bloody 
sweat" may be trying to get up into the stomach, and maybe an 
enema from a long tube is now essential to produce quiet. To 
relieve restlessness and the aches and ''tired feeling"' it is well to 
briskly rub the legs and back with a coarse towel under the cover 
every three to six hours. Massage through the cover is some- 
times grateful. 

After sixty hours, in ordinary, examine the urine. If albu- 
min appears as a trace give more fluids. If the quantity increases 
from five to twenty per cent, give turpentine in seven to ten drop 
doses every four hours. For five per cent albumen nothing but 
more fluid is necessary ; if it increases to seventy-five per cent give 
more turpentine. Rub the chest and back with turpentine, not so 
much for absorption as to put your charge in a turpentine atmos- 
phere, to prevent him from smelling and tasting the medicine. Do 
not let the patient know that you have examined, or want to ex- 
amine, the urine ; have portions saved without his knowledge. 
It is amazing what quantities of turpentine can be taken without 
harm. There is no danger from strangury. I have given half, 
sometimes a teaspoonful, to children where there was suppression, 
and generally with good effect. But it is not advisable to give 
all that may be considered necessary in a case at one dose. Tur- 
pentine is a diffusible stimulant and a good styptic; it is laxative 
also. I have never seen a particle of benefit follow the adminis- 
tration of digitalis. Large enemas of water, about the temperature 
of the air, or cooler, placed high up, do much good if retained. 
Please note that the kidneys are not inflamed, but rather para- 
lyzed. 

For sleeplessness after the second night give sulfonal in fifteen 
to thirty grain doses, and repeat if necessary in three or four 
hours. Bromide and chloral are good, but are often borne badly. 
I used trional once with good result. Sleeplessness is often due 



GEXERAL DISEASES. 301 

to the odor from a dirty quilt or pillow ; sometimes to a lumpy 
mattress. These may seem trivial, but it is a doctor's business 
to look out for his patient. In some cases a woolen shirt — a 
sweater — is necessary, as in restless children and persons who will 
not keep the arms under cover. 

As the fever subsides diminish the remedies and increase the 
food, but it is generally unsafe to give anything like milk or eggs 
before the fifth or sixth day. The patient will not starve to death, 
but if he is fretted by a great lot of rules, or unpleasant attendants 
and surroundings he may not get well. 

Collapse. 

Collapse is a horror. Generally an enema with a little whisky 
and turpentine, given with a long tube, will do good. Hypoder- 
mic strychnia, brisk rubbing" of arms and legs and back with mus- 
tard is to be adopted. It is always necessary to procure an action 
from the pylorus downward. If this is not done there will soon 
be black vomit. A deft administration of olive oil, one to three 
ounces, is a life-saver. Collapse is usually caused by an influence 
equivalent to surgical shock, and the organs through which the 
shock comes are in order of frequency — the stomach, from excess 
of, or because of faulty food ; the skin, from chilling by getting up 
or getting uncovered ; the brain, from hearing bad or unwelcome 
news. To avoid collapse it is needful to prevent any shock to the 
organs mentioned. Whatever the origin of the collapse, the treat- 
ment is the same, but in case of mental disturbance some abusive 
or consoling talk, as the case requires, must be indulged in also. 
More people have died in consequence of too early or imprudent 
feeding than is generally supposed. I have saved a life by insist- 
ing on having a window shut down to prevent the entrance of "the 
lovely breeze." Free ventilation has caused the death of many; 
so has the sleepy nurse who let the rolling patient get naked in 
the chilly hours of the early morning ; so has the gossipy neighbor, 
who consoled the convalescent by telling him of the death of a 
friend, or the outbreak of fever in the town to which the patient's 
family had fled. There is another source of collapse. During 
early convalescence there is an excessive venereal desire, and un- 
der such circumstances conscience is much dulled or dead. It is 
necessary to warn the partner, who is not sick, or arrange that 
man and wife shall not be left alone until convalescence is complete. 



302 - GENERAL DISEASES. 

Thus nurses of the opposite sex are to be doubted and tabooed, if 
possible. 

I am confident that collapse, whatever its apparent cause, is 
generally accompanied with an obstruction of the small intestine 
and oftener in the upper part. I would like to say that the shock 
caused the obstruction. . Sometimes it is food — then high up ; 
sometimes it is intussusception — then lower down ; sometimes it 
is clue to a contracted colon, but if the patient could have been per- 
mitted to lie in quiet there might have been continued peristalsis. 
There are some who dispute my mechanical theories and the 
effects of mental conditions. 

Secondary Fever. 

The secondary fever (that of after five clays) is a ptomain 
poisoning and needs some modifications of the routine. Give anti- 
pyretics and high clysters for effect and increase the food. Ice to 
the head and rubbed down the spine, every half hour rolling the 
patient from side to side, will do good. Alcohol will do much 
good at this stage ; the patient's choice is the form to use ; brandy 
is the worst form as it produces hiccough. Dry catawba has 
served me well. Gin is the best form, as it may assist the kidneys. 
I have never seen any benefit follow champagne ; ginger ale is bet- 
ter. 

Continue the turpentine if the albumin compels it. I think 
guaiacol rubbed into the skin of the abdomen would be beneficial, 
/ but I never had a chance to try it ; if put into the stomach, it is 
liable to cause nausea and eructations. Chronic vomiting after 
four or five days may be relieved by cocaine, or one- tenth grain 
doses of calomel with one grain soda bicarbonate frequently re- 
peated. One-twelfth grain closes of morphia hypodermically do a 
lot of good; watch the urine, for opium increases the albumin or 
the chance for it. Small blisters over the stomach do good service. 
Sometimes bismuth serves a good purpose ; peppermint and soda 
have served well, but it is necessary to compel a through and 
through action of the bowels. 

For five days give no food but thin starches. Milk kills, as 
does every sort of food that requires stomach digestion. Lime- 
water alone sometimes gives comfort to the stomach, but mixed 
with milk it often causes the milk to stay in the stomach to be- 
come curds in the half rotten duodenum. Patent and predigested 



GENERAL DISEASES. 303 

foods are all right in the ptomain fever and recuperating stages, 
but hurtful for the first four or five days; so with opium and 
alcohol. 

The physician should remember always that the senses of the 
yellow fever patient are as acute as those of a puerperal fever pa- 
tient and that all necessary subterfuges must appear to be absolute 
truth. I know of many deaths due to actual truth, brain shock and 
collapse following. There is no other febrile disease in which 
physic and the mind play such prominent roles. A constipated 
patient, or one who has a dreadful fear of the fever, will, as a rule, 
not recover. 

Primarily, it is the physician's duty to be, or to appear to be, 
frank, nonchalant, observant, cheerful, confident, hopeful and posi- 
tive ; he must convince the patient by word or manner that he 
for one among the sick is not suffering with the "prevailing" fever 
and is not very sick. Except in disputed cases, a half dozen ques- 
tions will elicit all the information needed for detailed action for 
the next twenty-four hours. As patients later in the disease are 
all embracing in acuteness of senses, it is necessary to be frank 
(not truthful) and to remember and adhere to whatever has been 
said before. Many a life has been lost by ill-advised sympathy, 
too much nursing and attention, too frequent dosing, and sense- 
less gossip. 

If obedient, the more ignorant the nurses in this disease the 
better. All the professional nurses I have seen are at odds with 
the doctor and continuallv try to convince the patient that when 
all fails he will bring order out of chaos, and, presto ! the patient 
will be cured. The nurse should have only sense enough to obey 
orders. Dumb nurses would be ideal in all critical or extra 
critical cases. The doctor should know how to direct the nurse 
as to his duties and to emergencies and crises, and should be care- 
ful that no disputes arise. The sick person must depend upon 
nurse as well as doctor. I know of too many preventable, but not 
prevented, deaths due to strife between physician and nurse : un- 
fortunately, in some instances the doctor was to blame in being 
careless in giving directions. I know of some cases sacrificed to 
the zeal of the nurse who "knew more than all the doctors." 



304 - GENERAL DISEASES. 

First Aid To Suspicious Cases. 

In the Brownsville epidemic I was compelled to include within 
the cordon a small region inhabited by non-immunes. If I had 
acted in accordance with the laws of Texas then in force, I would 
have exposed many more people and had an area to care for nearly 
as large as Rhode Island. To protect the people outside the 
infected town and inside the guard line I supplied my guards and 
patrols with the medicines then in use, i. e., compound cathartic 
pills, mustard, and quinine pills, and gave directions for their use. 
Nearly a hundred cases were treated by the guards, in the coun- 
try, without a death. Since then I have advised interested persons 
to provide the pills, mustard, and acetanilide in advance. Were I 
to outfit a guard line now, I would furnish compound cathartic 
pills, compound acetanilide tablets, and mustard, to be used while 
the doctor was being summoned, I have suggested to Major 
O'Reilley, of the Army Medical Corps, that the pills and tablets 
be added to the first-aid package of the troops who go into yellow 
fever regions, with instructions for a man to take a pill at bedtime 
if his bowels were not freed during the past day; to take more 
if he has a chill in the night, and to^take a tablet if he suffers with 
headache. It takes time to get a physician, and I feel confident 
that if men are given a little instruction and the few necessary 
remedies there will be less suffering and perhaps less mortality. 
It is well known to Southern physicians that a dose of compound 
cathartic pills will stop a malarial attack, particularly in negroes, 
and it is believed that the use of the coal tar derivatives has less- 
ened the necessity for cinchona in the treatment of malarial dis- 
eases. 

I have tried to tell how to treat the yellow fever with a limited 
number of remedies. Any person who will carefully follow direc- 
tions will succeed in keeping the death rate at about four per 
cent, and, counting accidents, age, habits and conditions, that is as 
low as can be expected. 

For ridding the premises of infection after recovery, see chap- 
ter on Disinfection. 

Prevention. 

As one in perfect health is less susceptible to this disease, per- 
sonal hygiene is very important. In addition to avoiding every 
known means of infection, the bowels, kidneys and skin should be 



GEXERAL DISEASES. 305 

kept in first-class condition. Constipation is especially to be 
guarded against ; the bowels should be moved every day, by a mild 
cathartic if necessary, but excessive purging should be avoided. 
Partake freely of ripe, juicy fruits and fresh vegetables, all of which 
are safer for being cooked — safest for being boiled. It is not 
thought that yellow fever is a water-borne disease, but it is a wise 
precaution, especially at this time, since malaria is often a danger- 
ous complication, to boil all the drinking water and thus free it 
from germs of every kind. Indulge but sparingly in meats ; do 
not use alcoholic drinks ; avoid great bodily fatigue, and undue ex- 
posure to the sun ; for this purpose the pith helmet is the best hat 

The house should be on high, well-drained ground, where 
there is free circulation of air and plenty of sunshine, and so 
planned that the sun can shine into every room sometime during 
the day. There should be no closet under the stairs, and no dark 
or damp cellar. Damp ground, dark rooms, deep shade, imperfect 
sewers, decaying matter and all kinds of filth, favor the develop- 
ment of this infection and are a constant menace. 

As chilling is one of the most dangerous of all the causative 
influences, great care must be taken not to cool quickly when 
heated, not to get wet, and not to expose the body to night air. 
Soft woolen clothing should be worn next the skin, plenty of 
blankets used at night, and care taken at all times to avoid draughts 
of cool air. There is far more danger from infection at night and 
on damp or cloudy days, hence leave your home as little as possible 
except when the sun is shining brightly ; from ten o'clock till four 
is considered the safest for being abroad. If obliged to be out in 
the early morning, first drink a cup of hot coffee and wear warm 
clothing. During the day throw open all parts of the house to the 
free ingress of pure air and bright sunshine, but close them as night 
approaches. As the infection is denser or more virulent near the 
ground, as far as possible sleep up stairs. 

Keep the mind occupied with work or pleasing themes, and 
do not worry about anything. The authorities are not agreed that 
fear of the fever increases the danger of contracting it, but they 
are united in declaring that when once the disease has seized a 
patient, great fear as to the result is one of the most damaging ele- 
ments in the case. Many, who would probably have recovered had 
they been kept in ignorance, have been frightened to death on 
learning that their disease was yellow fever. 
20 



CHAPTER III. 

By R. E. McVey, M.D. 



THE LIVER. 

The liver is the largest gland in the human body, and in many 
respects the most wonderful, since it varies more in size, shape and 
functions than any other. Not only does its weight in adults range 
from less than two to more than five pounds, but it varies greatly 
at different times in the same individual while in health, and much 
more when under the influence of disease. Its average size in 
infancy is one-twenty-fifth that of the person ; in adult life one- 
thirty-fifth, and in old age one-forty-fifth; but in disease it may 
be reduced to one-eightieth, or enlarged to one-seventh of the 
weight of the entire body. In the average man of good develop- 
ment it is about a foot 
across the longest way, 
which is from side to side 
of the trunk, six or seven 
inches wide, some three 
and a half inches thick at 
its largest place and con- 
tains about one hundred 
cubic inches. 

In shape it also var- 
ies much, conforming to 
that of its owner. Any 
constriction of the waist, 
as tight lacing, not only 
presses this organ up or 
down so that it is often 
permanently displaced, 
but frequently causes 
deep fissures or creases 
in the substance of the 
liver itself. While these 

Position and Relative Size of the Liver. abllOmial COllditioilS are 

306 




GENERAL DISEASES. 307 

most usual among women, they are not uncommon in men accus- 
tomed to wearing tight belts. 

It is situated under the right lower ribs, its lower border cor- 
responding to the lower border of the ribs and its upper part is 
on a level with the fifth rib. It extends from the right side to a 
little past the middle line of the body. When enlarged it may 
extend much beyond these boundaries. 

Although many of the most skillful scientists have given a 
great deal of study to the liver, some of the changes wrought 
within its tissues are still very little understood. It is not likely 
that aliitssecretscverwill be found out until new methods of inves- 
tigation shall be devised, but it has been learned with a good deal 
of certaintv that its functions are at least fourfold. They are: 

First. The preparation of glycogen or animal starch. 

Second. The purification of the blood. 

Third. The formation of new blood from the nutritive and 
life-giving elements, as derived from the digested food and poured 
into it through the great portal vein. 

Fourth. The secretion of bile — a yellowish-green, bitter, 
sticky, nauseous fluid, most of which is stored in the gall-bladder 
until needed to aid in the processes of digestion, when it is dis- 
charged into the intestine. A powerful antiseptic, it is supposed 
to also serve a useful purpose in preventing putrefactive changes 
within the intestines ; and, as it consists in part of what is thought 
to be waste and impurities from the blood, it acts as a scavenger 
by carrying this refuse into the channel leading to the sewer of 
the body. 

The liver works all the time but is very much more active dur- 
ing the periods of digestion immediately following meals, and it is 
probable that the chemical changes then taking place in the forma- 
tion of glycogen, blood and bile, also make sufficient heat for 
immediate wants, and that as this supply subsides the deficiency 
is met by chemical reactions upon the starch and fats ; in other 
words, by burning fuel stored up for this purpose, and into the 
furnace with them are thrown the worn-out blood corpuscles and 
tissue debris. 

Xot only are itS'duties many and laborious, but its mechanism 
is so delicate that its finest ducts and tubules are only one two- 
thousandth of an inch in diameter, and as it must begin work 
upon the products of digestion as often and almost as soon as any 



308 GENERAL DISEASES. 

food or drink is taken, and must continue to receive and transform 
them until digestion is finished, no matter how poor the quality or 
excessive the amount, it is not strange that of all the organs of 
the body the liver is the one most likely to become disordered. 
Then, too, its derangements act more quickly than those of any of 
its comrades, upon the other organs, especially the stomach and 
intestines, and scarcely later upon the nervous system, particu- 
larly the brain. 

This extreme sensitiveness, though often disagreeable to its 
owner, is a great advantage to his organism, for by its protests it 
warns him when he takes too much, too little, or the wrong kind 
of food or drink, when he takes them at the wrong time or swal- 
lows them too quickly, when he gets too much or too little exer- 
cise, or too little sleep, or has been exposed to cold, or is too 
anxious, or worries, or overworks his mind. The sage was doubly 
wise when to the question, "Is life worth living?" he replied: 
"That depends upon the liver," for so dependent are all the other 
organs upon this great gland that, more than the determination 
and will, it decides in advance what its owner shall enjoy or suffer 
and what he may and may not accomplish in life. 

CONGESTION OF THE LIVER. 

Congestion means the act of gathering into a mass, but in 
medical language the term is used to designate an unnatural 
accumulation of blood in any part of the body. It is the most com- 
mon of all liver disorders. As already stated, this organ is very 
sensitive to kind and quantity of food and drink, temperature, rest, 
exercise and emotional excitement. When from any cause its cells 
are rendered unable to properly transform and remove from the 
blood certain materials as fast as absorbed and sent up from the 
intestines, the minute branches of the portal vein, by which they 
are distributed throughout the liver, are obstructed, and, becom- 
ing engorged and enlarged, so press upon other parts of the 
mechanism as to interfere with their free and perfect operation 
until, as the work continues to accumulate and the pressure in- 
creases, the whole gland becomes more and more helpless. 

Symptoms. — The symptoms of this disease are numerous and 
varied, but of course do not all appear in any one case. The fol- 
lowing are some of them : Either diarrhea or constipation, head- 
ache, mental confusion, nausea, flatulence, low spirits, loss of appe- 



GENERAL DISEASES. 309 

tite, sense of fullness, tenderness just below the ribs, pain in the 
back or right shoulder, loss of strength and flesh, alterations of 
vision, sleeplessness, sometimes jaundice, dizziness and difficult 
breathing, weariness and aching of the limbs. 

Treatment. — In many cases all that is needed to restore an 
enlarged liver to perfect health is rest, but as that is permitted to 
this organ only when the current of digested nutrients absorbed 
and borne to it from the intestinal surfaces is greatly diminished, 
the amount of food should be cut down to a very low limit. The 
diet must be rigid both in quantity and kind, and the food most 
acceptable to the stomach may be just the thing you should not 
take. The popular idea that lean meat, dry bread and tea and 
coffee without milk are good in this disease, because easy to 
digest, is wrong, for they impose too much work upon the liver 
after leaving the alimentary canal. 

Although farinaceous foods do not digest as readily, they are 
better, for when they finally enter the portal vein they are so far 
on their way to grape sugar as to cause the liver no trouble. 
Hence eat foods composed largely of starch, such as corn and oat 
meal, hominy, rice, sago, potatoes and fruits, either fresh, canned 
or dried. Nearly all vegetables are admissible, but peas and beans 
should be eaten sparingly. Take no eggs, unless it be a yolk now 
and then, and discard most meats, especially pork and veal. 
Boiled chicken, codfish and oysters may be taken, but pastries, 
stimulants, alcoholic drinks and tobacco should be let alone. 
Choose from this list such articles as best agree with you. Take 
mild exercise in the open air every day that the weather permits, 
and as far as possible avoid warm, damp, malarious regions. 

CHRONIC CONGESTION OF THE LIVER. 

In cases of long standing the derangements may have gone 
so far that rest alone cannot restore a healthy activity, and often 
the congestion is not limited to the liver, but has extended to all 
the internal organs. Of all remedies for chronic simple enlarge- 
ment of the liver there is no other nearly as good as calomel if it 
be properly used, which means that it should be taken in very 
small doses, and its value is much enhanced by combination with 
pepsin. One-fifth grain of the former with two grains of the 
latter, after dinner two or three times a week, may be sufficient. 

For quiet, useful and sure action upon the liver sulphate of 



310 GENERAL DISEASES. 

soda is also excellent. It should be taken before breakfast in tea- 
spoonful doses in a half-glass of water. For cases of obstinate con- 
stipation, or of congestion caused by severe colds, one-fifth of a 
grain of calomel every two hours until five doses have been taken, 
and followed the next morning by a tablespoonful of castor oil, is 
a very reliable remedy. 

The following is an old prescription and preferred by some : 

Sulphate of soda four ounces 

Sulphate of magnesia one ounce 

Chloride of ammonium two drams 

Nitrate of potash two drams 

Common salt one ounce 

Powder finely, mix and keep well stoppered, in a large-necked 
bottle, and take a teaspoonful in a half-glass of water every morn- 
ing before breakfast. For quickly removing the bad taste and set- 
ting the system in order, this has few equals. 

Effervescing phosphate of soda, in tablespoonful doses, is also 
good in these cases. 

Sometimes all that the liver needs besides rest is a thorough 
washing out, to accomplish which drink a quart or more of water 
every day, in half-pints at equal intervals between meals. It should 
be boiled for fifteen minutes, then thoroughly cooled, and may be 
flavored with lemon to suit the taste. 

Linseed meal poultices and hot fomentations applied to the 
region of the liver are often useful. The wet girdle is an excellent 
device for this trouble. It is best made from a piece of toweling 
nine or ten feet long ; wet about half of it, wring enough to prevent 
dripping, fold the wet end into several thicknesses large enough to 
cover the front half of the body, and, having placed it in position, 
wrap the dry part over it and around the body and secure the end 
with pins. It should be worn for weeks, sometimes for months, 
and it is better to have several and wash and boil them often. 

If they injure the skin they should be discontinued for a few 
days, then worn again. 

In cases where there is much pain, counter irritants, such as 
mustard poultices, may be applied, but they should not be worn 
long enough to blister. Massage, rubbing and pressing should 
not be employed, for such treatment of an inflamed and tender 
organ needing rest might do much harm. 

The custom of prescribing tonics for the liver, such as iron, 



GENERAL DISEASES. 311 

gentian and quinine compounds, is often pernicious. Neither 
should the appetite be whipped up with condiments and bitters. 
Nausea is nature's method of calling a halt when the body has 
been too richly fed. You must obey its orders or suffer its pen- 
alties. Absolute abstinence from food is not advised. Meals 
should be taken at the regular hours, but must be made of the 
articles indicated and be as small as consistent with bodily health, 
until the liver resumes its normal activity, after which practice such 
self-denial as will not lead to a recurrence of the malady. 

BILIARY CONCRETIONS. 
(Hepatic Colic. Gall Stones.) 

Gall stones are granular, friable masses formed in the liver, 
in the ducts leading from the liver to the gall-bladder, in this blad- 
der itself, or in its outlet. They are from millet seed to lien's tgg 
size ; and are rounded, angular, faceted, or of very irregular shape, 
as where one stone is made up from several smaller ones, adhering 
together. They rarely occur in infancy and childhood, are com- 
mon to both sexes during and after mature life, and are most 
often found in women beyond the age of forty. 

They are yellow, brown, black, or brownish-green. 

Just how they are formed is not known, but certain condi- 
tions of the genial health are thought to be factors, and stag- 
nation of the bile is probably favorable to their formation. Usu- 
ally there is but one or two present at one time, but occasionally 
they exist in great numbers, and may completely fill the gall-blad- 
der. Not until the stone begins its passage through the duct, or by 
stopping up the duct obstructs the passage of its fluids, is the pa- 
tient likely to feel that anything is wrong, but at this stage, if the 
stone is of any considerable size, there is sure to be very severe 
pain, which is relieved only when the stone passes through into 
the intestine or, as sometimes happens, returns from the duct into 
the bladder. 

These stones vary greatly in composition, but in by far the 
greater number of cases they are composed of coloring matter and 
the fatty substances of the bile, in which liquid this variety is solu- 
ble whenever it contains less than a saturating amount of these in- 
gredients, hence, by changing slightly the composition of the bile, 
stones in the gall-bladder may sometimes be dissolved, and the 
formation of new ones prevented. \\ nere the stone has entered 



312 GENERAL DISEASES. 

the duct, relief can be expected only when it has passed through. 

Soon after the attack has subsided the stone may usually 
be found in the dejections by diluting with water then passing 
them through a coarse muslin or sieve, but in some cases the pa- 
tient retains them for several days. 

Symptoms. — The disease is a difficult one to diagnose with 
certainty, unless there has been a previous attack followed by 
jaundice, accompanied with constipation and light-colored stools; 
or unless the stones have been found. Heredity often throws some 
light upon the problem, as it is an affection likely to run in families. 
It is often associated with gout or neuralgia. It is likely to come 
on a feAv hours after a hearty meal, if not severe at first, soon be- 
coming so, and continuing to increase until the patient is in ter- 
rible agony. The seat of the pain is in the upper part of the abdo- 
men and under the free ends of the false ribs on the right side, 
from which it may radiate backward and upward, but never down- 
ward. The attack may be brought on by menstruation, indiges- 
tion, strong emotion, or by a sudden jolt or strain. There is likely 
to be vomiting and violent retching, and the patient is soon re- 
duced to extreme weakness. The attack may last but a few hours, 
but in severe cases has been known to continue several days. 

Treatment. — As relief will come as soon as the stone passes 
through the duct into the intestine and little can be done to has- 
ten the process, the first effort should be to ease the pain, and 
this should be done if possible without resorting to narcotics. 
Heat is an anesthetic, not as powerful as morphia, but one in whose 
train no dangers follow. Place a large, moist, linseed-meal poul- 
tice between several thicknesses of paper and lay it upon a hot 
stove, turning often to keep it from burning, and when w T ell heated 
apply the poultice as hot as can be borne to the affected parts, then 
heat another to clap on as soon as the first shall cool a little, and 
continue the process until the pain is relieved. In some cases ice 
bags bring more relief than hot applications. Striimpell recom- 
mends equal parts of chloroform and olive oil to be rubbed into 
the skin over the seat of pain by very gentle movements, but it is 
probable that this gentle massage does more than the drugs to 
bring the relief. 

These stones are soluble in chloroform. An old remedy, and 
one that still has its advocates, was to locate the stone with the 
hand by feeling for it at the center of pain, then to throw into it 



GENERAL DISEASES. 313 

a teaspoonful of chloroform with a hypodermic syringe. The stone 
is thus dissolved, or so much of it as to facilitate its passage 
through the duct. The serious effect of the drug upon some peo- 
ple is the main objection to this treatment. 

Drinking pure olive oil in very large doses has permanently 
cured many severe and obstinate cases of this disease. A half- 
pint should be taken once every four hours until relief has been 
obtained or a quart has been consumed. Be very careful to get 
pure olive oil for this purpose. The concoctions made from cot- 
ton seed, and other cheap substitutes, that are sold as olive oil, 
might be very injurious. 

If the patient shows signs of collapse because of excessive 
pain the strength should be kept up with stimulants. Quinine, 
good wine, or strong coffee may be used for this purpose. A 
stone of irregular shape or very great size may become so im- 
pacted in the duct as to be removable only through surgical aid. 
The operation, if properly performed, is not a dangerous one and 
should not be postponed too long. Whatever the treatment it 
should be followed by a mild laxative to move the bowels gently, 
and measures to build up the general health. The patient usually 
recovers and the disease is often permanently cured. 

ICTERUS. 
(Jaundice.) 

Jaundice is not a primary disease, but a result, a symptom 
pointing to some other disease to which it is due. The name is 
from a French word, signifying "yellowness," and is used to desig- 
nate a morbid state of the system, characterized by the presence 
in the blood of coloring matter from the bile, which stains yellow 
the skin and the white of the eyes. Whether in health the blood 
contains any bile is uncertain. It was long supposed that it did, 
and that it was mechanically filtered therefrom by the liver, but 
the weight of opinion now is that it is a secretion formed in the 
liver, the ingredients being drawn from the blood and portal vein, 
but differing much from the product itself; and that jaundice is 
caused, not by a failure of the liver to act upon and purify the 
blood, but by absorption into the blood of bile already formed and 
excreted by that organ. 

As fast as bile is formed it is conveyed through the biliary 
ducts to the gall-bladder and there stored until needed to aid 



3 14 ' GENERAL DISEASES. 

in the processes of digestion, when it is poured through the com- 
mon duct into the intestine, for that purpose. This natural order 
may be interrupted by any obstruction in this duct, as by a stone 
(see Gall Stones), by the formation of a plug of mucus within the 
duct, by the closing up of the duct by a catarrhal thickening of 
its tissues, or by outside pressure as from a tumor. 

Stopped thus in its course, the flow of bile is turned back 
into the liver, and absorbed and carried away by the blood. A 
complete closing of the duct is not needed to accomplish this, but 
merely that its caliber be narrowed enough to cause the bile to pass 
through it with some difficulty. 

All cases of jaundice thus caused are known as jaundice from 
obstruction. 

Experiments upon animals have shown that the pressure un- 
der which bile is excreted is extremely small, and that it enters al- 
most as readily into the circulation of the blood as into its normal 
outlet. Even in perfect health very little force will thus divert it; 
the amount required being only the slight pressure needed to 
overcome that of the blood in the liver tissues. These forces are 
so nearly balanced that any considerable decrease of the natural 
blood-pressure leads to a turning back of the bile into the general 
circulation. This is what happens when jaundice follows great 
general bleeding, strong mental emotions, venomous snake bites, 
or any other depressment that renders the heart unable to do 
nearly its full amount of work. This variety of cases is called 
jaundice by absorption. 

Malaria is a very prolific cause of jaundice, principally be- 
cause the coloring matter, set free in the destruction of red cor- 
puscles by the germs of the disease, is left floating in the blood 
and stains the tissues when a little later it is absorbed by them. 

There are other varieties, but as these two classes embrace 
nearly all cases of the disorder, we will not discuss the others. 

Symptoms. — The diagnosis of jaundice is usually very easy, 
for it is clearly seen in the yellow color in the face and eyes. 
The tint of the skin' much resembles that caused by the action of 
the sun, but tan never affects the color of the eyes and jaundice 
does. The yellowness appears first in the eyes, then in the face, 
and gradually extends over the entire body. The mucous mem- 
branes are not usually affected and the lips retain the redness of 
health. The urine becomes high colored, sometimes very $ark, 



GENERAL DISEASES. 3] 5 

and stains yellow. The sweat, except under the armpits, seldom 
stains. 

There is little if any pain ; if present it is due, not to the 
jaundice, but to some accompaniment, or to its cause. The 
patient is likely to be fretful, peevish and much inclined to sleep, 
and his mind becomes sluggish and heavy. There is likely to 
be diarrhea, with stools of light clay color. In most cases of 
jaundice from obstruction there is severe itching, liable to extend 
over the whole body and to be worse at night. Loss of flesh 
and weakness usually follow, and there is slow, feeble pulse, and 
changes in the senses of taste and sight. Hemorrhages of the 
mucous membranes often occur, of which bleeding from the nose 
is the most common. In chronic jaundice hemorrhages are very 
grave indications ; and nervous symptoms, such as delirium, coma 
and convulsions, are usually soon followed by death. 

Treatment. — The treatment should be mainly directed to the 
disorders causing the jaundice, but as the latter may itself work 
serious injuries to the liver and the general health, it should not 
be neglected. Diet must be the chief reliance, for it is often very 
difficult to affect the malady with medicines. The patient should 
live upon such food as lean beef, mutton, skimmed milk and 
strained broths ; and must avoid fat in every form, also sweet fruits, 
tea, coffee and all alcoholic drinks ; and, if there be much trouble 
from gas in the stomach, food containing sugar and starch must 
also be discarded. 

Relieve constipation by alkaline remedies, as a tablespoonful 
of Epsom salts every four hours until the bowels act freely. It 
is no longer thought wise to purge the patient, or to give emetics ; 
for, although they may do good in some cases, they are liable 
to do harm. Digestion and secretion of urine are both aided by 
taking from one and a half to three ounces of lemon juice daily ; 
and there may be free use of lemonade. Injections of from one to 
two pints of water, at 60 degrees Fahrenheit, retained as long as 
possible, are recommended. 

Warm rooms and warm clothing should be provided for the 
jaundiced, and their chilliness is best treated in this way. Warm, 
vapor and Turkish baths are good to stimulate excretions by the 
skin, and their efficiency may often be increased by gentle massage. 
Itching may be relieved by using a five per cent ointment of calo- 
mel and lard, or by washing in warm soft water containing three 
per cent of carbolic acid.- 



316 - GENERAL DISEASES. 

Little can be done for hemorrhages, except when they are 
from the nose. An ordinary nose bleed can usually be controlled 
by bathing the face and head in cold water and applying cloths 
wet in cold water to the forehead, the patient using care to stand 
erect with the head thrown well back and his arms raised above 
his head, the blood being absorbed by a sponge, cotton wool or 
similar material held by an attendant. The frequent posture of 
bending over a basin is wrong, as it is likely to stimulate the 
bleeding. The nose bleed accompanying jaundice is often so 
persistent as to require plugging of the nostrils with cotton. 
Examination should then be made, and if blood is passing down 
the throat the back of the nares. should also be plugged. To 
do this thread a small strong cord through one end of a short 
piece of leather shoestring, trim the other end smoothly and run 
it through the nose into the throat, and with forceps draw it 
through the mouth until about twelve inches, of the small cord 
extends beyond the lips; tie this firmly around a piece of cotton 
as large as required to stop a nostril, leaving the free end of the 
cord about eight inches long, and draw the cotton back through 
the mouth snugly into the nares, then tie together the ends of 
the cord hanging from the mouth and nose. Serve the other 
side of the nose in the same way, then plug the nostrils with 
balls of cotton as before. The blood thus confined will soon 
form a clot, press upon the membranes and stop the flow. After 
twenty-four hours remove the lower plugs, cut the cords, draw 
the wads to which they are fastened out through the mouth, and 
gently cleanse the nostrils with cool water. Should the bleeding 
begin again, repeat the plugging. 

The gravity of a case of jaundice depends upon its causes, 
for when they are overcome the jaundice usually fades away. 
The first sign of recovery is the return of color to the dejections, 
the last is the disappearance of color from the urine. The dis- 
order is likely to run about six weeks and the patient usually 
gets well. 



CHAPTER IV. 

By R. E. McVey, M.D. 

RHEUMATIC FEVER. 
(Acute Rheumatism.) 

Although the germ has not yet been discovered, the phe- 
nomena of rheumatic fever are best explained by regarding it as 
a germinal disease, the poison of which is carried in the blood 
to all parts of the body, but affects most seriously those tissues 
which are composed wholly or largely of white or yellow fibers, 
such as the ligaments of the joints, the tendons of the muscles, 
and the membranes or sheaths covering the bones, cartilages, 
glands and muscles. Rheumatism is a specific inflammation of 
these fibrous tissues. Other parts are usually affected too, but 
their involvement is thought to be only sympathetic, due to 
their close proximity to these tissues ; although it is probable 
that the serous membranes, which are the linings of the closed 
cavities of the body, may be directly infected and become diseased 
in the same maimer as the fibrous ones. 

The disease is most common between the ages of fifteen 
and forty, but is sometimes found in children from five to ten 
years old. It is more frequent in the temperate zones than in 
either very warm or very cold countries. Much exposure to 
cold was long considered the cause of the disease, but is now 
thought to be only a condition favorable to its development. 

Severe labor and strain are also conducive influences, and 
about one-third of all cases of the disease are hereditary ; that is, 
the sufferers have inherited such peculiarities of structure as to 
predispose them to the disease ; but neither this nor any other 
of the influences named ever caused rheumatism. The system 
must first be infected ; but when the poisonous germs have been 
admitted, these favoring conditions aid in their rapid multiplica- 
tion, and thus become very important factors in developing the 
disease. 

Symptoms. — The first symptoms are likely to be chilliness, 
then rise of temperature, weakness and general malaise, but not' 

3i7 



318 , GENERAL DISEASES. 

often as much headache and thirst as in other fevers ; tongue cov- 
ered with a dirty white fur and red at the tip and sides; urine 
scant, acid and turbid, depositing reddish sediment upon standing. 
Pain in the limbs and perhaps in other parts also soon follows, in- 
creases rapidly and settles in a few or many joints, which soon be- 
come swollen and very painful. The suffering is likely to be severer 
at night than during the day, and is increased by the slightest 
movement, such as that caused by a person walking over the 
floor or the jar of a car or heavy wagon passing rapidly in the 
street. There is profuse perspiration with sour odor. The patient 
feels helpless and will not try to move lest he add to his torture 
and pain. The large joints are the ones most likely to be affected, 
such as the knee, ankle, wrist, elbow, shoulder and hip. The 
most characteristic feature of rheumatism is the tendency of the 
pain to shift from one part of the body to another and to attack 
new parts, meanwhile remaining in the joints first visited, or 
returning to them, or leaving them entirely for new locations. 
The temperature is usually from ioo degrees to 104 degrees, 
but in severe cases with heart complication it may go as high as 
no degrees, when it is very likely to be fatal. Its liability 
to attack the membranes of the heart is its only really dangerous 
feature, for however painful, if this organ be not affected, it 
almost always runs its course and the patient recovers in from 
one to three weeks, though it sometimes lasts seven or eight, 
if not influenced by treatment. The fever is remittent in char- 
acter and goes and comes quite suddenly and from no apparent 
cause. The same is true of the swelling in the joints. In a large 
proportion of cases the structures of the heart are affected. This 
feature is usually accompanied by dull pain beneath the breast- 
bone and a sense of heaviness in the chest. This is a grave form 
of the disease and should be treated with care, but the patient 
often recovers. Many suppose that rheumatism of the heart is 
caused by driving the disease from some other part to that 
organ by the use of external remedies, but this is a mistake. 
The trouble is a diseased condition of the heart itself, usually 
consisting of an inflammation of its outer covering, called the peri- 
cardium, which is a membrane composed largely of fibrous tissues, 
not exactly like those composing the ligaments of the joints, 
but very much resembling them. Modern investigators think 
that rheumatic infection upon entering the system is attracted 



GEXERAL DISEASES. 319 

to this membrane in the same way as to the fibrous structures 
of the joints, but so much more slowly that it does not become 
affected until from five to eleven days later than the joints. 
Pericarditis is not the only danger, for endocarditis, or inflam- 
mation of the heart's inner lining, may follow, in which case, if 
death does not occur, the valves are likely to suffer permanent 
injury. As proper treatment at the beginning of the attack 
usually cures acute rheumatism in from one to four days, the dis- 
ease may in almost every case be arrested before reaching the 
heart, and it is difficult to see how the importance of prompt 
and intelligent treatment can be made more emphatic than by a 
plain statement of the nature of the disease. 

Treatment. — Since acute rheumatism is due to a septic poison 
that affects the whole system, it must be mainly treated by internal 
remedies in a general way, rather than by local applications. 
Salicylic acid is the great specific for rheumatism. It is best used 
in the form of Parke, Davis & Co.'s, or Warners Salicylic Acid 
Compound, and should be taken in doses of a teaspoonful every 
four hours. It is not as likely to unsettle the stomach as most 
forms of the drug, but if not within the reach of the patient, the 
next best form is salicylate of soda. Take from ten to twenty 
grains every two hours, but if it causes vomiting reduce the 
dose or take the same amount of bicarbonate of soda a few times 
instead, then return to the salicylate. As soon as the pain and 
swelling begin to subside, reduce the dose. As the salicylate dete- 
riorates rapidly, that found in stock in the drugstores is very apt 
to be worthless, for which reason it is better to have the druggist 
prepare it specially when needed. Many prefer wintergreen oil, 
one of whose principal ingredients is salicylic acid. It should 
be taken upon sugar or in capsules, from ten to fifteen drops 
every four hours. The bowels should be kept open by giving 
a tablespoonful of Epsom salts as often as may be required. 

The alkaline treatment also has its advocates, and in some 
cases is a valuable remedy. It consists of the following : 

Acetate of potash two drams 

Bromide of potash two drams 

Iodide of potash two drams 

Essence of wintergreen four drams 

Glycerin three ounces 

^ ater three ounces 

Mix and give a teaspoonful every four hours. 



320 - GENERAL DISEASES. 

In cases that refuse to yield to the salicylic treatment it is 
well to combine the alkaline treatment with it, giving first one, 
then the other, every four hours. The following is valuable 
with either treatment : 

Olive oil two ounces 

Chloroform four drams 

Laudanum two drams 

Tincture of iodine four drams 

Tincture of aconite two drams 

Mix and use as a liniment upon the affected joints, or use : 

Salicylic acid three drams 

Lanolin three drams 

Oil turpentine three drams 

Lard three ounces 

After either of these wrap the joints in cotton batting or soft 
flannel. 

Milk is the proper diet, but soups, soft eggs and other light 
foods are permitted. An abundance of acid drinks may be taken 
as often as desired. All alcoholic stimulants, meats and hearty 
food should be let alone. 

The patient should remain in bed several days after he thinks 
he is well and use care to avoid exposure which might invite a 
recurrence. One attack seems to predispose to other assaults, 
hence the patient must be more careful than ever before not to 
expose himself to dampness, cold or other influences likely to 
assist in developing the disease. 

CHRONIC RHEUMATISM. 

Chronic articular rheumatism is a mild but persistent inflam- 
mation of the ligaments, membranes and cartilages of the joints, 
often resulting in their enlargement from thickening of the parts. 
Writers usually consider it under two heads : The first consisting 
of those cases that result from acute rheumatism ; the other, of 
those that are chronic from the start and develop slowly until 
the joints become permanently altered. Some regard the two 
classes as of very different causation ; others maintain that both 
may result from the same cause. There is much about the disease 
that is not yet understood, but it is certain that the same influ- 
ences that favor the development of acute rheumatism are also 



GENERAL DISEASES. 321 

active agents in bringing forward both forms of this. It is most 
common in cold, damp, changeable climates, and finds its victims 
chiefly among those whose occupations require severe muscular 
exertion and much exposure to wet and cold. The larger joints, 
too, and those most used are the ones most often attacked, but 
the heart is not as likely to be affected in this as in the acute 
form, although the cases in which it is diseased are by no means 
rare. On the other hand, chronic rheumatism is not often hered- 
itary, is more common among women than men, and is mostly 
a disease of advanced age, being rarely seen in children and youth. 

In cases of long standing the inflamed and thickened liga- 
ments sometimes adhere to and unite with the softer tissues lying 
next to them and the joints become fixed and immovable, often 
very badly deformed. 

Symptoms. — There is great variety in the symptoms, as they 
are modified by the severity of the disease, the degree of its devel- 
opment and the habits of the patient. From slight pain, stiffness 
and swelling in one or many joints, there may be considerable 
pain and every degree of swelling, distortion, rigidity, to immov- 
able stiffness and loss of several joints. 

The pain in the joints is of a dull, heavy character and is 
greatest at nig'ht. The stiffness is usually greatest in the morn- 
ing, and is somewhat relieved by exercise. Often when at rest 
through the day there is little if any pain, but resting permits 
the stiffness to return and it is soon as great as before. The 
symptoms are sure to be aggravated by changes in the weather, 
especially by increased dampness. Although the trouble is in 
his tissues, the rheumatic has been said to carry a barometer in 
his bones, so accurately do his stiffness and pains enable him to 
foretell coming storms. The tissues around the joints are likely 
to become thickened and show the greatest changes. There is 
often constipation and scant, high colored urine. Again the 
general health may be good. In case of bad nutrition, a tea- 
spoonful of the following mixture may be taken three times a day : 

Bitter wine of iron four ounces. 

Liquor potas. arsenitis one dram. 

In case of acute attacks give either of the treatments for 

acute rheumatism until the pain is relieved, but not after that, 

for they are of little value for reducing thickened membranes and 

stiffened joints. 
21 



322 - GENERAL DISEASES. 

Warm alkaline baths (common baking soda, a tablespoonful 
to each two gallons of water, makes an excellent one) should be 
taken once or twice every week, and be followed by free friction. 
Turkish baths are also very valuable in the treatment of this 
disease. 

Adhesions in the sheaths of tendons and other fibrous tissues 
can best be remedied by massage, passive motions, etc., con- 
tinued month after month if necessary. In all friction and mas- 
sage, care must be taken not to irritate the tender parts, or more 
harm than good may be done. 

Wintergreen or peppermint oil, well rubbed in over the 
affected joints and followed by applications of hot sand, salt 
or cornmeal, will often afford great relief in acute attacks. It is 
best to have several bags, about a foot square and half filled with 
dry sand, that wjiile some are in use the others may be heating 
in an oven, that by frequent changes the parts may be kept as 
hot as can be borne. A convenient and excellent way of apply- 
ing heat is to fill a large jug with boiling water, cork securely 
and wrap in cloths sufficiently to prevent burning the patient, 
then place it against the affected part as he lies in bed. 

Avoid exposure and wear only woolen clothing next the 
skin. If able move to a mild, dry climate. Discard all alcoholic 
drinks and very strong tea and coffee. Eat only nutritious, easily 
digested foods, as chicken, tender beef, game of all kinds, bread 
and butter, milk, cream, eggs, soups and acid fruits, and take 
moderate outdoor exercise in good weather, at stated times, but 
carefully guard against occasional overexertion. Keep the bow- 
els regular and build up the general health as much as possible. 
The disease is very stubborn and its cure depends more upon 
climate and carefully regulated hygiene than upon medicines, 
but as some cases yield to treatment, internal remedies should 
not be neglected. The road is long and recovery can be reached 
only through persistence. Taking treatment for a time, then 
neglecting it until a new attack drives the sufferer to his reme- 
dies, will never cure chronic rheumatism. 

MYALGIA. 

(Muscular Rheumatism.) 

Muscular rheumatism is a painful affection of the muscles, 
attended by most of the phenomena that characterize articular 



GEXERAL DISEASES. 323 

rheumatism. It is commonly attributed to the same cause, but 
as it occurs chiefly in the muscles most subjected to stretching 
and strain, such as those of the shoulders, neck and loins, it is 
probably often due to a tearing or rending of their fibers. It is 
never general in its distribution throughout the system, like the 
articular form, but is confined to a single muscle, or to a single 
set of muscles. It may precede, accompany or follow the artic- 
ular form, and it may be entirely independent of it. Many dis- 
eases, such as some of the infectious fevers and cases of chronic 
poisoning, are accompanied by symptoms commonly called rheu- 
matism, and until the true nature of trichinae was discovered 
its painful manifestations were classed under the same head. 
When the true nature of rheumatism is better known, it is prob- 
able that the term will be used in a more restricted sense and 
be made to include less than it does now. 

Its favorite seat seems to be the loins. When located there 
it is called lumbago; when in the neck, torticollis; in the shoulder, 
omalgia ; and so on, these names designating not different dis- 
eases but different locations of the same disease. 

Symptoms. — Pain, more or less intense, in the affected 
muscle. This may be of a dull, heavy character until the muscle 
is brought into action or placed under strain, when it is greatly 
intensified ; if in the back, it is almost impossible to stoop down. 
The muscles are very sore and tender when touched or pressed 
lightly, but often not as painful when grasped firmly. The pain 
is seldom permanent in one place, but wanders here and there. 
It is of both kinds, acute and chronic, and may last from a few 
hours to several months, and be of every degree of severity. 

Treatment. — The treatment should be the same as in similar 
forms of articular rheumatism. Careful massage, preceded and 
followed by applications of dry heat, usually brings great relief. 
Electricity, if properly used, is also an excellent remedy. Four 
grains of quinine every four hours for three or four days usually 
relieves the trouble. When the disease is obstinate, one-tenth of 
a grain of calomel every four hours until the bowels move freely 
is beneficial. In chronic cases a four-grain dose of quinine at 
bedtime, in connection with the calomel treatment, is often useful. 
Sometimes hot vapor baths, by producing profuse perspiratidn, 
afford relief, but this remedy should be used sparingly if the 
heart is diseased. The internal remedies should be continued for 



324 GENERAL DISEASES. 

some time after the pain subsides and exposure and overexertion 
carefully avoided, since the disease is prone to return. 

RHEUMATOID ARTHRITIS. 
(Deforming Rheumatism.) 

Rheumatoid arthritis is a chronic affection of the membranes 
and cartilages of the joints, the adjoining muscles and the artic- 
ular ends of the bones. It is most common in women, is some- 
times hereditary and most often attacks its victims when from 
forty to fifty years of age. Severe mental shocks, anxiety and 
care are thought to be causes, especially if coupled with com- 
bined dampness and cold when the body is insufficiently nour- 
ished from lack of good food. Poor health is a very prominent 
cause. 

It may follow the change in life and is often associated 
with uterine disturbances, due, it is thought, to the reduced con- 
dition of the system at such times. The injurious and debili- 
tating tendencies resulting from the privations of poverty and 
the lowered vitality caused by depressing influences of any kind 
predispose to the disease. It is aggravated by sudden changes 
in the weather. 

Symptoms. — The first symptom may be enlargement of one 
or more joints, but more often this is preceded by a tingling, 
prickling sensation like needles in the hands and arms, or by 
.neuralgic twitches in the ball of the thumb and inner side of the 
wrist. The disease comes on very slowly and is likely to first 
attack the overworked joints, as those of the fingers of seams- 
tresses, laundresses, etc. It differs from acute rheumatism in 
attacking the small joints first, and in not being accompanied 
by acrid sweat and little if any fever. 

Except in the quite rare cases in which it attacks the young, 
it is very chronic and spreads slowly from joint to joint with 
comparatively little pain; but the pain varies greatly in different 
cases, and in the same case from time to time. It is often most 
severe at night, being aggravated by the warmth of the bed; 
and as rest increases the stiffness, this feature is worst in the 
morning. Gradually the cartilages are worn away or absorbed 
sa that the bones come together in the joints and wear upon 
55 h other until their shape and normal bearings may be greatly 
changed. Their sockets often become much distorted from the 



GEXERAL DISEASES. 325 

gradual extension of the flanges, giving these joints a prominence 
that is increased by the shrinking and wasting away of their 
softer parts and the adjoining muscles, though the enlargement 
is mostly due to the increased size of the articular ends of the 
bones. As the joints grow more and more stiffened, until they 
become fixed and immovable, their pain and tenderness grow 
less, and new joints are attacked, to be also destroyed. Spreading 
thus from the smaller joints to the larger ones, the disease may 
go on for thirty years, and more, for it does not interfere with 
the general health and is limited only by the patient's life. 

Treatment. — First remove the patient from the depressing 
influences, prevent all anxiety and worry, and cheer and brighten 
her trains of thought. In the acute attacks, accompanied with 
fever, absolute rest in bed is best, but as these give place to 
the chronic forms, moderate exercise is an advantage, but should 
never be carried far enough to cause much fatigue. 

Except in the acute attacks the diet should be very nourishing 
and as plentiful as the patient can digest. Meat should be eaten 
freely and mustard taken with it. Malt liquors and good wines are 
an advantage if taken with the food. In an ounce of wine take 
from ten to fifteen drops of the syrup of iodide of iron with the 
meals three times a day, for a week, then skip three days, after 
which repeat as before. Good doses of cod liver oil should also be 
taken, especially during the winter months. 

After two months of the iodide and oil, leave them off for two 
weeks and take a warm bath each day, following it with good 
massage, but be careful not to continue them to the point of de- 
bilitating the patient, for she needs all her strength to combat the 
disease. If heart affection be associated with the arthritis, the 
baths must be very brief and taken with great care and if any bad 
results appear they should be discontinued. Keep the bowels 
regular and build up the general health. 

Some physicians prefer the bitter wine of iron prescription as 
used in the treatment of chronic rheumatism, given in this work. 
Five grains lithium carbonate two hours after meals is excellent. 

Local vapor baths and imbedding the affected parts in hot 
sand may afford relief. Some cases are so stubborn that all treat- 
ment fails. It is very important that the disease be fought most 
thoroughly at its first appearance, for as it progresses it becomes 
harder to subdue. Cases that are not cured are sometimes checked 
and held in abevance for vears. 



326 GENERAL DISEASES. 

GOUT. 

Gout is a joint disease caused by an excess of uric acid in the 
blood, in the form of urate of soda. It is most common in men, 
rarely occurs before the age of forty, and in two-thirds of the cases 
is hereditary. It may be a result of great fatigue, overexertion, 
or mental strain ; but usually it is brought on by excessive in- 
dulgence in wines and malt liquors. 

It was long called the disease of the rich, but is quite as 
frequent now among the poor. It is often associated with chronic 
lead-poisoning ; hence, is especially liable to attack house-painters, 
type founders and setters, lead miners and smelters, etc. It is 
found with many other disorders, such as bronchitis, pneumonia, 
neuralgia, catarrh of the urinary and intestinal organs, and 
affections of the heart and kidneys. When it attacks the in- 
ternal parts it is called irregular or retrocedent gout and is more 
dangerous. It may become chronic and is very obstinate. 

In severe cases the excess of uric acid in the blood may 
crystallize as urate of soda in the cartilages of the joints, perhaps 
also in the muscles and tendons, and form nodules that can be 
felt beneath the skin. In the vast majority of cases it locates in 
the joint that unites the foot and great toe, but it may appear in 
any joint, especially if it has been previously injured, as by a 
wound, rheumatism, etc. Except in cases of long standing, each 
attack is nearly always confined to a single joint. Around this 
abscesses sometimes form and concretions of the urate may escape 
from them. 

Symptoms. — Some or all of the following symptoms are 
usually present: 

Digestive disturbances ; loss of appetite ; weight and fullness 
in the stomach ; irregular bowels ; heartburn ; pain in the calves 
of the legs ; slight fever with chilliness ; mental depression ; head- 
ache and irritable temper. Sometimes the attack is without warn- 
ing of any kind, but acute gout always comes unexpectedly in 
spite of the premonitions, and surprises the patient like a thief 
in the night. Having retired and gone quietly to sleep, he is 
awakened about midnight by a severe pain which may be in the 
joint of the great toe, or in any other joint of the body. The pain 
rapidly becomes unbearable. The patient feels as if the affected 
joint were in a vise ; he sighs, moans and throws himself about in 
bed; the leg, or even the entire body trembles with pain. Soon 



GENERAL DISEASES. 327 

after the commencement of the attack, the skin covering the 
joint begins to swell and redden, and there is fever with a full 
bounding pulse, dry skin, intense thirst, concentrated, red urine 
and great mental excitement. 

Toward morning there is a remission, but the affected joint 
remains swollen, shining and very red, and the whole leg is slightly 
swollen. The next night the scene is repeated with equal severity. 
The following day brings another remission, and so on for a week 
or ten days, when the swelling, redness and pain gradually disap- 
pear, the skin peels away and the part returns to its normal state. 
This form of the disease is more common in Europe than in this 
country, but is here, too, and is increasing. 

Gout sometimes takes an eczematous form and a rash appears 
upon the surface of the body, in patches here and there. The skin 
tries to eliminate the excess of uric acid in the blood, and is in part 
successful. With the microscope crystals of the urate can be seen 
in the rash ; and often when there is no rash, they may be seen 
upon the skin covering the affected joints. 

Treatment. — First: Oxidation — which means taking pure 
cold water and plenty of exercise in the open air. Secondly: 
Diet — taking certain kinds of food and letting some kinds entirely 
alone. The total amount of food should be reduced, and the 
patient should live upon such food as lean meat, fish, broths, green 
vegetables, and small amounts of milk, eggs, oatmeal and bread, 
and a very little fruit. He must discard all fat meats, potatoes, acid 
food and very hearty things of every kind ; also wine and all malt 
liquors. If whisky is used at all at first, it must be in small 
quantity, the amount gradually reduced and soon entirely dis- 
continued. 

The leg should be placed in as comfortable a position as 
possible and the affected parts wrapped in soft Manuel or cotton- 
wool. Hot compresses are useful, so are applications of dry heat. 
Regulate the bowels by enemas. 

From three to five grains of carbonate of lithia in a glass 
of water may be given three times a day. Fifteen or twenty 
drops of the wine of colchicum three times a day soon brings 
relief, but as such internal remedies arrest the elimination of 
the poison, the next attack will come sooner because of their use, 
hence the better practice is to discard them in acute gout and rely 
upon exercise and persistently rigid diet. When one has had 



328 GENERAL DISEASES. 

gout he is sure to have it again, sooner or later, and prudence lies 
in making the intervals between the recurrences as long as pos- 
sible 

DIABETES. 

Diabetes is a disease characterized by an excessive amount of 
urine, and is of two kinds : That called Diabetes insipidus (Poly- 
uria), in which the urine contains very little if any sugar, being al- 
most entirely water; and that known as Diabetes mellitus, or 
sugary diabetes, in which the urine contains sugar, sometimes in 
very large amounts. 

The former is not nearly as serious as the latter and is usually 
curable. Although the average patient discharges from three 
to twelve quarts of urine in twenty-four hours it may not cause 
much depression of the system, and cases sometimes run for many 
years without any serious results, yet it is liable to reduce the vi- 
tality and pave the way for some other disease that will prove 
fatal. There are cases on record in which there was for a long 
time the enormous average discharge of from eight to ten gallons 
of urine daily. 

Diabetes mellitus is a most persistent, serious, and, in its se- 
verer forms, incurable disease. Beginning gradually and running 
a quiet, insidious course, it usually has a firm hold before the symp- 
toms have been noticed by its victim. The disease is not well 
understood, but many regard it as a nervous disturbance result- 
ing in a failure of the muscular tissues of the bodv to absorb 
or utilize sugar. During health there are from one to three parts 
of sugar in every one thousand parts of blood. When the pro- 
portion becomes greater than three the kidneys, to purify the 
blood, try to excrete the excess with the urine, the amount they 
throw out depending upon the condition of the excreting organs, 
the diet, and the extent or degree of the failure of absorption by 
the tissues. This failure results in enfeebled, wasted muscles, a 
worn, tired and anxious look and a ravenous appetite. The pa- 
tient is slowly starving for want of the nourishment he is unable 
to use, though furnished in abundance by the blood. 

Another class of investigators, among whom Purdy is prom- 
inent, maintain that it is a result of a deranged liver, whereby 
those nutrients called carbohydrates, which in health make fat, 
are broken up and their elements combined in such proportions 
as to form sugar and waste ; and that even albumin may be trans- 



GEXERAL DISEASES. • 329 

formed by chemical changes into sugar and urea, that its constit- 
uents are nearly the same as the united ingredients of these two 
substances which are not only found in diabetic urine but increase 
and decrease in the same proportions during the progress of the 
malady. 

A slow, chronic disease, it usually requires from one to three 
years to run its course, but sometimes takes less time, and oc- 
casionally lasts ten. twelve, or even more years. It is more com- 
mon among men than women, and chiefly occurs between the 
ages of 25 and 65 years. It is sometimes hereditary. Among the 
causes to which it is attributed are exposure to wet and cold, 
emotional disturbances, mental exhaustion, anxietv and grief, 
sedentary habits, physical violence, concussions of the whole body, 
diseases affecting the nerve centers, acute fevers, gout, rheumatism 
and syphilis. By some it is thought that high altitudes and cold 
climates are unfavorable. 

Symptoms. — The most characteristic symptom is a largely 
increased amount of urine, often averaging from one to three 
gallons per day, paler than the natural color, and discharged with 
increasing frequency. Its irritating quality is likely to be so 
great as to cause a burning sensation in the urethra and inflam- 
mation at its opening, and sometimes irritation of the skin wher- 
ever it may happen to reach. It is heavier than healthy urine, 
has a sweet taste, often attracting flies and bees when discharged 
upon the ground, and has a sweetish odor resembling that of 
sweet apples or hay, and when discharged intd a vessel or shaken 
in a bottle forms abundant white froth that is slow to disappear. 
The average amount of sugar daily passed in this way ranges 
from twelve to twenty-four ounces, but there may be much 
less or a good deal more. Urine analysis is the most certain way 
of diagnosing diabetes, and in many cases, until the disease 
is far advanced, it is the only way. but the presence of sugar, 
which is the positive proof, can often be detected by simple 
evaporation. Put all the urine passed in twenty-four hours in 
a kettle and boil it until it has evaporated : if the residuum is a 
sweetish mass diabetes mellitus is indicated. 

The patient for a time may be well nourished, but sooner 
or later his muscles, especially those of the legs, become weak, 
and there is great fatigue upon slight exertion. The mouth is 
dry and parched, there is unquenchable thirst, and, as already 



330 GENERAL DISEASES. 

stated, a ravenous appetite, but later, because of overtaxing the 
digestive organs, this condition may give place to loss of appe- 
tite and even to loathing of food; and the red, glazed tongue 
of the earlier stages may become thickly covered with white fur. 
There is great emaciation and loss of flesh, sometimes amounting 
to fifty pounds or more in a few weeks. The patient becomes 
irritable, fretful and sleepless, and may be the victim of neuralgia 
and other nervous disorders. He has a low temperature and 
sensations of chilliness and takes cold very easily. Boils are a 
frequent accompaniment, sometimes great numbers of them. 
Gangrene may appear. There are often changes of vision. Con- 
sumption is a frequent accompaniment. 

Treatment. — Most cases of diabetes insipidus and the milder 
forms of diabetes mellitus can be cured, but their treatment 
should begin early, and be followed with great persistency. The 
objects aimed at are a lessening of the manufacture of sugar in 
the body and stimulation of the muscular tissues to a greater 
use of that which is made. The former must be mainly accom- 
plished by diet. All sweets must be avoided, and as far as the 
patient can refrain from foods containing starch he should do so, 
for it is from starchy food that the sugar in the body is principally 
derived. He will probably take less of these in the long run 
if permitted to have them in limited quantity than if wholly 
denied them until his craving for them becomes so great as to 
lead him to break away from all restraint. Formerly the prin- 
cipal diet was fats and such other articles as assist the stomach 
to tolerate fats, but a strictly meat diet is no longer advised. 
Fresh meats, such as mutton, beef, poultry and wild game may 
be taken in moderate amounts, but as livers and oysters contain 
a good deal of sugar they should be excluded. Green vegeta- 
bles, such as lettuce, water cress, radishes and cucumbers, and 
acid fruits and berries may be taken raw. Cabbage, cauliflower, 
string-beans, spinach, asparagus and celery may be eaten if cooked. 
Green peas and all beans except string-beans are better omitted. 
Cream, buttermilk and cheese may be freely used. Wheat bread 
and potatoes are so largely composed of starch they must be 
taken very sparingly, if at all. 

The following substitute for bread may be more safely used : 
One cup Graham flour, one cup of the best bran previously 
scalded, one cup boiling water, two eggs, German yeast or baking 



GEXERAL DISEASES. 331 

powder, salt to the taste, one cup of milk or water; mix with 
a spoon and bake in loaves. 

Almond flour beaten up with eggs, raised with a little baking 
powder and baked in small tins, is recommended by some as very 
palatable and safe. A milk diet is now thought to be good only 
in very mild cases. 

The tincture of opium, in ten-drop doses three times a day 
before meals, was long the standard remedy, but it is not as 
much used now. In many cases the following gives better results : 

Arseniate of soda one grain 

Carbonate of lithia one dram. 

Mix, divide into twenty powders and give one three times a 
day in water after meals. 

The following will often relieve the itching" which sometimes 
accompanies this disease : 



& 



Calomel twenty grains. 

Acetate of lead thirty grains. 

Extract of belladonna fifteen grains. 

Subnitrate of bismuth one dram. 

Carbonate of zinc thirty grains. 

Benzoated lard two ounces. 

Apply once a day and paint the parts twice a day with phenol 
sodique. 

The patient should take all the exercise in the open air that 
he can without very much fatigue. Horseback riding is the 
best. He must avoid all nervous, mental and physical excite- 
ment ; must wear warm flannels next the skin and use great care 
against taking cold. A warm bath every other day, followed 
by brisk rubbing with dry towels, is a great advantage. He 
may drink all the cold water he wishes, but must let alcoholic 
stimulants of all kinds alone. The urine should be tested for 
sugar every ten days and the treatment regulated accordingly. 
The disease runs its course most quickly in the young. Strong, 
healthy men in the prime of life stand the best chance for 

recovery. 

OBESITY. 

(Corpulency. Fatness.) 

Obesity or corpulence is such an excessive development of 
fattv tissue in the bodv as to become burdensome. It occurs 



332 GENERAL DISEASES. 

twice as often among women as among men, and is most frequent 
after forty years of age. Its most common cause is the habitual 
taking of too much food. Most people past middle life are in 
the habit of eating too much, though the excess at any one time 
may not be large. Too little exercise in the open air is another 
fruitful cause, and is often associated with the first, yet a few 
cases of obesity are found among persons who take a great deal 
of exercise and in those who eat less than a normal quantity 
of food. The condition can be regarded as a disease only when 
the habits of eating, drinking and exercise fail to account for it. 

Alcoholic beverages very often cause obesity, and it is some- 
times a result of disease, as of paralysis or other nervous dis- 
orders, anemia, etc., and it may be the first warning of the 
approach of some malady more serious than itself, in which case 
the danger signal is of great importance if the condition be 
complicated with heart or kidney disease. A very large propor- 
tion of those suffering from obesity inherited the tendency from 
their ancestors. Diabetes, gout and rheumatism are its frequent 
associates. 

Treatment. — The main thing in the treatment is a carefully 
regulated diet, and while the authorities differ as to some of the 
articles that should be placed upon the prohibited list, all agree 
that the first step should be a diminished quantity of food, that 
a gradual reduction is better than a sudden, severe one and that 
the scanty fare must be enforced for months to be successful. 
The diet should be varied enough to keep up the health and 
strength, and a proper proportion should be maintained between 
its carboniferous and nitrogenous elements, that is, fats and 
starches are not to be discontinued, but limited. Most agree, 
however, that if butter and sugar are allowed at all, they must 
be taken in very small quantities. 

Very little liquid should be taken with the meals, and no 
drink allowed until two hours or more thereafter. All alcoholic 
beverages, especiallybeer, must be discontinued. 

Various courses of diet have been recommended. Lyman, 
in his "Practice of Medicine," says: "Milk and eggs furnish the 
best diet for this purpose. The patient should take, for twenty 
days in succession, not more than one-half pint of milk and one 
Qgg every three hours during the waking portion of the day. 
No other food or drink should be allowed. Under this treatment 



GENERAL DISEASES. 333 

the bowels become constipated and require gentle laxatives or 
enemata. As first this restriction of the diet causes faintness, 
weakness and sometimes dizziness, but in a short time these 
unpleasant symptoms disappear and the disagreeable consequences 
of obesity rapidly diminish. At the end of three weeks the 
diet may be varied and gradually increased." 

Yeo, in "A System of Therapeutics," Vol. I, edited by H. A. 
Hare, Philadelphia, 1891, gives the following excellent summary: 

"The albuminates in the form of animal food should be strictly 
limited. Farinaceous and all starchy foods should be reduced 
to a minimum. Sugar should be entirely prohibited. A mod- 
erate amount of fats should be allowed. 

"Only a small amount of fluids should be permitted at meals, 
but enough should be allowed to aid in the solution and digestion 
of the food. Hot water or warm aromatic beverages may be 
taken freely between meals, or at the end of the digestive process, 
especially in gouty cases, on account of their eliminative action. 

"No beer, porter or sweet wines of any kind should be 
taken and no spirit of any kind except in very small quantity. 
It should be generally recognized that the use of alcohol is one 
of the most common provocatives of obesity. A little Hock, 
still Moselle, or light claret, with some alkaline table water, 
is all that should be allowed. The beneficial effects of such diet 
will be aided by abundant exercise on foot, and by such a use of 
saline purgatives as to secure a complete daily unloading of the 
intestinal canal. 

"Of animal foods, all kinds of lean meats may be taken, 
poultry, game, fish (eels, salmon and mackerel are best avoided), 
eggs. 

"Meat should not be taken more than once a day, and not 
more than six ounces of cooked meat at a time. Two lightly 
boiled or poached eggs, or a little broiled fish, may be taken at 
one other meal. 

"Bread should be toasted in thin slices and completely, 
not browned on the surface merely. Hard captain's biscuits may 
also be taken. 

"Soups should be avoided, except a few tablespoonfuls of 
clear soup. 

"Milk should be avoided, unless skimmed and taken as the 
chief article of diet. All milk and farinaceous puddings and 
pastries of all kinds are forbidden. 



334 GENERAL DISEASES. 

"Fresh vegetables and fruits are permitted. 

"It is important to bear in mind that the actual quantity of 
food permitted must have a due relation to the physical devel- 
opment of the individual, and that what would be adequate in 
one case might be altogether inadequate in the case of another 
person of larger physique." 

A very important part of every mode of treatment is mus- 
cular exercise, and it should be taken in the open air if possible, 
thus the better increasing heart action, inducing deeper and 
more rapid breathing, and assisting in a fuller oxidation of the 
adipose tissue. Mountain climbing is one of the best forms, 
rowing is good, horseback riding can be recommended, and a 
brisk, swinging walk until considerably fatigued is excellent. 

Baths stimulate the excretory functions of the skin, and to 
this end a warm bath, containing a tablespoonful of common 
baking soda to the gallon of water, lasting from fifteen to thirty 
minutes, and followed by a cold spray and brisk rubbing, is 
valuable. 

The advertised anti-fat nostrums are often positively inju- 
rious. Taking vinegar, or large amounts of other acids, using 
opium or tobacco, and starving the body to reduce flesh, must 
all be condemned as likely to lead to more serious consequences. 
Some cases of obesity are incurable, and in these it is better to 
attempt only a mitigation of the suffering by measures prescribed 
by reliable physicians and known to be safe, than to surrender 
one's self to the advertising charlatan, who in consideration of 
a fat fee may promise the impossible. 

ACUTE NEPHRITIS. 
(Bright' s Disease.) 

The kidneys are very often diseased. The chief reason for it 
is that the body must eliminate all injurious matter that enters the 
blood and must do it very largely through these organs, which 
often become infected with the poison they are required to throw 
out. B right's disease was named after Richard Bright, an Eng- 
lish physician, who discovered some of the pathological features 
of this form of kidney disease which might more properly be 
known as nephritis. It is classified in two forms : Acute and 
chronic. The acute form runs its course in a few days or weeks, 
and in rare cases lasts for some months. It is very liable to follow 



GEXERAL DISEASES. 335 

scarlet fever, is often induced by other infectious diseases, as 
measles, small-pox, typhus fever and diphtheria, also by cholera, 
syphilis, etc., and sometimes is clue to other causes. Pregnancy 
is sometimes thought to favor its development. 

As the kidneys are so located as to make direct examination 
of them impossible we must, to determine their condition, rely 
upon urine analyses and such phenomena in other parts of the 
system as have been found to accompany their derangement ; but, 
as these phenomena are often associated with other disorders, a 
positive diagnosis of this disease can be made only by analysis of 
the urine, which in this trouble contains albumin, casts and some- 
times minute, and sometimes considerable, quantities of blood. 
Such an analysis requires experience, use of the microscope and 
some knowledge of chemistry, hence the patient should early 
consult a competent physician and secure an examination that will 
leave no doubt as to the nature of his malady. 

The symptoms vary in different cases but some of the fol- 
lowing indications are always present: Pain in the back and 
limbs ; headache ; chilliness followed by fever ; diminished urine 
but frequent urination accompanied by burning sensations; con- 
stipation, but sometimes diarrhea; nausea; vomiting; bron- 
chitis; swollen ankles and legs ; swollen eyelids and face, the dropsy 
sometimes increasing until the patient- is greatly distressed. 

Treatment. — The patient should be kept very quiet, should 
remain in bed and be covered sufficiently to induce constant slight 
perspiration, thus somewhat diminishing the work of the kidneys. 
Hot fomentations upon the small of the back. If there be no 
heart trouble, hot baths lasting from thirty minutes to an hour, 
their temperature kept up by additions of hot water, followed by 
thorough rubbing, precautions against taking cold, and cover- 
ing with warm blankets to produce profuse sweating. To aid 
in securing this result drink freely of warm water. The wet pack 
is in many cases useful. A dose of senna every other day to 
thoroughly move the bowels and eliminate injurious products 
that are normally excreted by the kidneys is especially useful 
in dropsical cases. But little medicine should be used. The diet 
should be milk exclusively. Many have been cured by the "milk 
treatment," which consists of taking no other food or medicine. 
He may drink freely of water and lemonade. Meats and stimu- 
lants are positive!}' forbidden. When there is great distress chloro- 



336 GENERAL DISEASES. 

form, rather than narcotics, should be used. Opiates of all kinds 
are very bad for this disease, and mineral waters and medicines 
to act upon the kidneys would better be let alone. 

Until far advanced the symptoms in the chronic are much 
the same as those in the acute form, except as revealed by the 
microscope, and the treatment is almost identically the same in 
both forms, hence, we will not here discuss chronic nephritis, but 
will add that if the patient wears warm flannels and carefully 
guards against taking cold he will be benefited by mild exercise 
each day in the open air, though this must not be continued until 
there is fatigue, and he must never go out when the air is either 
cold or damp. Sun baths are useful and his room should have 
an abundance of sunlight. Two or three quarts of milk should 
be taken daily, and the chances for recovery will be much im- 
proved by abstaining from all other food. 

NEPHROLITHIASIS. 
(Gravel. Kidney Stone.) 

This disease is most common before the age of fifteen and 
after that of fifty years. It is usually due to a depressed or 
nervous condition, such as results from gout, rheumatism, dys- 
pepsia and self-abuse. It rarely occurs from local causes, such 
as a catarrhal and ulcerative condition of the mucous lining of 
the pelvis of the kidney or of its prolongations, detached par- 
ticles of which serve as nuclei about which the urine salts gather 
and adhere until a stone is formed. The presence in any of the 
vesicles of the kidney of a solid body, though very minute, as a 
clot of blood, or shred of membrane, may become the center of 
a stone. How the salts thus gather and form a calculus without 
such a nucleus at the start, instead of being washed out with 
the urine, is unknown, but it is probable that in by far the great- 
est number of cases the stones are thus formed and are due to 
constitutional causes alone. 

The disease is not always painful. Sometimes the gravel, 
while small, are carried by the urine through the ureter into the 
bladder with little or no pain; sometimes they become large 
enough to obstruct the passage of the urine, inflammation sets 
in and the patient undergoes great pain, which usually, though 
not always, subsides with the passage of the stone; and there 
have been cases in which one or both kidneys contained large 



GENERAL DISEASES. 337 

stones without at all inconveniencing the patient. The disease 
is much more common in men than in women. 

Symptoms. — Small concretions or reddish or whitish sedi- 
ment in the urine when allowed to stand, and high colored urine 
that on standing deposits many acid crystals ; dull, aching pain 
deeply situated in the small of the back, running down the side 
into the thigh, calf of the leg and foot, or running into the groin 
and testicle; sometimes pain very sharp and severe in these re- 
gions after hard jolting; these pains may run through all stages 
of severity and end suddenly after lasting from a few minutes 
to several hours, rarely a day; nausea and vomiting; frequent 
and urgent urination. 

Treatment. — In the early stages of the disease the patient 
should carefully regulate his habits and diet and occasionally 
drink alkaline water. He should not eat heartily and should 
wholly abstain from such acid food as tomatoes, rhubarb, aspara- 
gus, and from wild game, shell-fish and highly spiced viands, 
should use little sugar, no beer and few stimulants ; but may have 
bread, butter, milk, potatoes, eggs, beef, chicken, fish, rice, oat- 
meal, coffee and tea if taken while fresh and hot. 

The medicines recommended by Morrow are citrate of potash, 
from ten to thirty grains, from three to four times per day ; or the 
citrate or carbonate of lithia, two to five grains three times a day. 
Hot baths and hot fomentations over the kidney are valuable. 
Large draughts of cold water should be taken often ; if the stom- 
ach is unable to retain it, frequent enemas should be given, the 
object being to increase the urine and thus help the passage 
of the stone through the ureter. The patient should be kept 
quiet and half unconscious during the severe pain. If hypodermics 
of morphia over the kidneys are not sufficient to do this, ether 
or chloroform should be used. It is very important that the 
patient be made as comfortable as possible. Relief from pain 
often results in relaxation of the parts and passage of the stone. 
In very severe cases a surgical operation may be the only re- 
course. 

CONTRACTED KIDNEY. 

This disease is most often found among old people. Both 

kidneys are usually diminished in the same degree, which in rare 

cases may be to one-third their normal size. In some cases it is 

regarded as a form of chronic Bright's disease ; in some it follows 

22 



338 GENERAL DISEASES. 

closely upon acute Bright's disease, as where the latter is a sequel 
of scarlet fever; and it sometimes appears as a primary disease. 
Its chief causes are alcohol, lead poisoning and uric acid. It may 
also result from malaria and syphilis. 

Many other disorders are associated with it, as valvular heart 
disease, gout, uremia, bronchitis, certain forms of asthma, dropsy, 
disturbances of vision, severe headache, sometimes confined to 
one side of the head and sometimes darting down the neck, 
vertigo, poor appetite, irregular bowels, enlarged liver, profuse 
nose-bleed, hard pulse, clear and abundant urine. 

Although none of these symptoms are conclusive, the pres- 
ence of any considerable number of them are strong indica- 
tions, and should prompt the patient to secure several analyses of 
the urine, made at different times, that its persistent average com- 
position may be accurately determined, for this is the only way of 
diagnosing the disease with certainty. If the disease is present 
the urine should be found to be lighter than normal because con- 
taining less salts and other solids, should contain a few hyaline 
casts, some albumin, often some white and, more rarely, a few 
red blood corpuscles. 

It is probable that contracted kidney is causative of most or 
all the disorders found in company with it. In the spirit of mu- 
tual helpfulness that seems to possess all parts of the body, as 
the kidneys become contracted, their filtering tubes diminished 
and their capacity for purifying the blood impaired, the heart 
tries to aid these organs in their all important work of purifica- 
tion by increasing the pressure and forcing the liquid through 
the remaining tubules more rapidly. Thus for a time the work 
is done by a part that should have been shared by all of the tubules, 
but as the degenerative changes go on and the filtering areas 
continue to contract, more and more heart pressure is required 
until that organ, able no longer to bear its ever increasing bur- 
den, becomes itself diseased. The increased blood pressure may 
have resulted in hemorrhages of the nose, stomach, intestines, 
lungs or other organs, but when the heart becomes unable to do 
the extra work complications rapidly multiply. The blood being 
no longer purified by an elimination of its salts and other urinary 
ingredients, uremia is especially liable to appear with its train 
of ills, such as headache, vomiting, diarrhea, pruritus, coma and 
convulsions, sometimes ending in death. The sight may be de- 



GEXERAL DISEASES. 339 

stroyed through retinitis; dropsy is one of the complications to 
be feared ; and sometimes apoplexy suddenly terminates the dis- 
ease. Still the attack may pass off and the patient rally. 

Not until the disease is far advanced is the patient likely to 
notice any symptoms to excite his suspicions, hence, it is usually 
impossible to determine how long he has been affected. It is 
probable that the disease often lasts ten years, or even longer. 
It is generally regarded as incurable, but the patient may be made 
very comfortable, and his life preserved for years. 

Treatment. — The treatment consists principally of hygienic 
measures. 

The patient must avoid everything that would lead to greater 
heart action, as fatigue, violent exercise or excitement, and 
should carefully refrain from eating or drinking that which might 
irritate the kidneys. According to his condition his diet should 
be meager or abundant, but milk is the principal food. Beer must 
be let alone, and all alcoholic beverages either prohibited or 
taken very sparingly. Corpulent patients should exercise moder- 
ately and regularly, but always stop short of fatigue. Warm 
baths are useful, with precautions against taking cold. The use 
of drugs could be of little value and might do much injury in 
this disease. 

THE DROPSIES. 
By T. H. Peers, M.D. 

We head this article with the plural because we desire to em- 
phasize the fact that dropsy may result from several diseases, but 
in itself is not a disease. Dropsy may be defined as a certain 
condition of the tissues of the body whereby they contain too 
large an amount of liquid. This liquid comes from the blood, 
oozing from the blood vessels, particularly the veins, into the 
surrounding tissues. Instead of spreading through the tissues, it 
sometimes collects in one of the serous cavities of the body, making 
a sac of fluid. \\ 'hen it thus collects in the abdominal cavity, it 
is called ascites. It sometimes collects around the heart, and 
sometimes about or within the brain. 

What, we may ask, are the conditions which tend to produce 
dropsy? A moment's thought will suggest the answer, which is: 
Anything that affects the walls of the veins so that the fluid part 
of the blood may leak through into the tissues, while the blood 
corpuscles are retained, and the things that favor this are pressure 



340 GENERAL DISEASES. 

inside the veins, and weakness of the walls of the veins. Those 
diseases, therefore, which allow the blood to accumulate in the 
veins, or prevent its return to the heart, or relax or weaken the 
walls of the veins, may produce a dropsy. From statistics it has 
been found that (i) Diseases of the kidneys, (2) Diseases of the 
heart, and (3) Wasting diseases like consumption are its most 
frequent causes. 

In acute inflammation of the kidneys, the swelling usually 
begins in the face, particularly around the eyes, where the cellular 
tissue is loose and flabby. It next shows itself in the feet, legs and 
scrotum, and may continue till there is a general diffusion of 
serous fluid into the connective tissues of the entire body, The 
serous cavities are next involved, and we may get dropsy of the 
pleura, of the peritoneum, and even of the pericardium. The 
swelling is not continuously progressive, but comes and goes, as 
the parent disease increases or decreases in severity. The fluid 
in the tissues bleaches them, giving to the skin a very white ap- 
pearance. If the skin is stretched very much it takes on a shiny 
appearance, and looks as though it had been greased. At times 
the distention is so great as to burst the skin, in which case the 
fluid leaks out rather rapidly, and the swelling decidedly dimin- 
ishes. The amount of swelling does not accurately determine the 
severity of the disease producing it, and the patient sometimes 
recovers after very severe swelling over a large portion of the 
body. 

In dropsy from heart disease, the swelling usually begins in 
the feet and gradually extends up the legs to the body. It then 
begins to affect the serous cavities, especially that of the abdo- 
men, where the fluid accumulates, and, unless the heart disease 
is arrested, or the fluid drawn from the abdominal cavity, the 
abdomen becomes very large. The operation of drawing off the 
water is called "tapping,' 1 and, if properly done, is not at all danger- 
ous. Sometimes large quantities of fluid are removed, and the op- 
eration has been performed as many as fifty times on one person. 
It is not a curative process, but gives the patient great relief, en- 
abling him to breathe much easier, to get around much better, and 
to lie down and sleep. Cathartics and medicines that cause sweat-, 
ing are often used, and help to carry off the fluid, but the treat- 
ment should be directed mainly to the heart, which is the real 
cause. 



GENERAL DISEASES. 341 

In wasting diseases dropsical accumulations often occur to- 
ward the end, and usually indicate a fatal termination. An ex- 
haustive discussion of this subject is not intended here, our pur- 
pose being, rather, to correct the popular belief that dropsy is a 
disease, and a very fatal one. Dropsy is only a symptom of an- 
other disease, and is not a serious symptom, unless the disease 
causing it is one dangerous to life. 



CHAPTER V. 



DISEASES OF THE HEART. 

By Louis C. Duncan, M.D. 

ANATOMY AND PHYSIOLOGY. 

The heart is a hol- 
low muscular organ, sit- 
uated near the middle of 
the chest, extending 
from the second to the 
fifth intercostal space, 
and from one inch to the 
right of the sternum 
(breast bone) nearly to 
the left nipple. It is 
about five inches long 
and four inches wide, and 
weighs from eleven to 
twelve ounces in men, 
and about two ounces 
less in women. It is large 
above (the base), and 
small below (the apex). 
A good idea of it may be 
obtained by examining 
the heart of a beef, which 
it resembles in shape. 
The heart is contained in a sac, called the pericardium, and 
is divided by a partition into two parts — the right and left sides 
of the heart. 

Each side is again divided into two parts or cavities. The 
smaller upper portion is the auricle, the larger lower portion 
the ventricle. The auricles have thin walls and merely receive 
the blood. The ventricles have thick muscular walls, which by 
their contractions force the blood out into the arteries, which 
divide and subdivide until they form a network of very minute 

34 2 




Position and Relative Size of the Heart. 



GEXERAL DISEASES. 343 

or microscopic vessels conveying this blood to all parts of the 
body, and thus supplying to them the nutrient elements of repair 
and growth. The final subdivisions of the arteries are called 
capillaries and are only one-three thousandth of an inch in diame- 
ter; some of them even less. 

The capillaries open also into minute veins, which unite with 
each other and form larger veins, and these again to form still 
larger ones, and so on to one large vein called the vena cava, 
their function being to gather up the blood, with its impurities, 
from all parts and convey it to the heart, whence it is sent to 
the lungs for purification, preparatory to being again sent through 
the arteries. 

The blood is carried by the vena cava to the right auricle ; 
thence passes through the tricuspid valve into the right ventricle, 
then through the pulmonary valve into the pulmonary artery, 
which carries it to the lungs, where it is oxygenated. It is then 
carried through the pulmonary veins to the left auricle, next passes 
through the mitral valve into the left ventricle, then through the 
aortic valve into the great artery — the aorta — and the aorta and its 
branches again carry it to all parts of the body. Thus the heart 
is really a pump, its function being to force the blood through 
the arteries to all parts of the system, thence to be returned 
again through the veins to the heart. 

In health, the heart beats about seventy times a minute, or 
about four times to each respiration, but this average is greatly 
modified during health by various influences, as exercise, age, 
excitement, etc. Thus, at birth the rate is 136; from two to 
seven, 97 ; fourteen to twenty-two, 76 : twenty-eight to thirty- 
five, 70 ; rifty-rive to sixty-three, 68 ; seventy-five to eighty-five, 
71 ; and the average is from seven to ten beats faster in females 
than in males. These figures are general averages, and do not 
apply to all cases. Some people always have a more rapid rate, 
and some a slower one. The pulse is slower while the body is in 
a recumbent position by about six beats per minute. 

Each beat sends a wave of blood through the arteries, just 
as each stroke of a pump sends a wave of water through a hose. 
This wave may be felt in any of the arteries which lie near the 
surface of the body, and is known as the pulse. So, by feeling 
the pulse we may determine how rapidly the heart is working, 
also how forcibly. The beating of the heart is an alternate contrac- 



344 GENERAL DISEASES. 

tion (systole), and expansion (diastole), the two making one beat. 
By listening to the heart two sounds can be heard. The first, long 
and dull, is caused by closure of the mitral and tricuspid valves, 
muscular contraction and the striking of the apex against the 
chest wall ; the second, short and sharp, is produced by the closing 
of the aortic and pulmonary valves. These sounds are altered in 
diseased conditions of the heart. 

Many constitutional diseases, as well as poisons, are spread 
through the body by means of the blood. Examples of these are 
hydrophobia, blood poisoning, diphtheria, syphilis, the poison 
from snake bites, and nearly all vegetable poisons. 

The blood is composed of a fluid known as blood serum, and 
of red and white corpuscles, or cells. One of the principal con- 
stituents of the red cell is an albuminoid substance called hemo- 
globin. It owes its red color to the iron it contains. When much 
oxygen is united with it a bright scarlet red is shown, as in 
arterial blood, and when the hemoglobin has exchanged a part 
of its oxygen for carbon dioxide, it becomes a dark bluish red, as 
in venous blood. The red blood cells have an average diameter 
of about one-thirty-two hundredth of an inch, and are round 
discs with concave sides. The white cells are about one-fourth 
larger, and, like masses of jelly, change their shape to meet emer- 
gencies, thus passing through openings, much smaller than 
their own average diameter, in the walls of the capillaries, and 
finding their way between the cells composing the various tissues, 
To nourish them and assist in the formation of new ones to take 
the place of those worn out, and to repair wounds and injuries. 
They are also capable of absorbing or taking up and carrying 
away injurious debris, so their function is at least two-fold : 
That of repairing the waste that is constantly going on in the 
body, whether in sickness or in health ; and that of carrying 
waste and injurious matter to the eliminating organs, the skin, 
lungs, liver and kidneys, to be thrown out of the system. It is also 
thought that they envelop any disease germs that chance to effect 
an entrance into the tissues, and that, when strong and healthy, 
they are able to destroy them by absorption, much as a jelly fish 
consumes its prey. 

As the digested food products are absorbed by the villi (the 
microscopic ducts of the intestines), they are carried into the 
blood, and become a part of it, and these nutrients, together 



GENERAL DISEASES. 345 

with the oxygen obtained in the lungs, are thus, with the help 
of the heart, borne to every part of the body and there build 
new cells, or are consumed to furnish animal heat and energy. 

The heart is one of the vital organs, its action being ab- 
solutely necessary to life. In the past it was regarded as the seat 
of life, including the mental and moral faculties now located in 
the brain. A survival of this idea, together with the present 
general knowledge of the heart, is responsible for the common 
belief that any affection of the heart is necessarily dangerous to 
life. YVe hear that a certain person has "neuralgia of the heart," 
or that some disease has "gone to the heart," and are gravely in- 
formed that the patient will now live but a few days; or, if by 
chance his life shall be spared, it can be for only a few uncertain 
years, with the fear of impending death haunting his every wak- 
ing hour. Like many other popular ideas, this is erroneous. 
True, many persons do die suddenly from heart failure, but many 
of these cases are results of some acute disease, like diphtheria 
or pneumonia, and are not due to a disease of the heart. 

The heart is subject to a number of diseases, some of which 
are not at all dangerous ; others render the individual physically 
unsound for life ; and a few so affect the heart that it may fail at 
any moment, thus constantly menacing the patient with sudden 
death. Even wounds of the heart are not always fatal. 

It is not possible for the average person to treat diseases of 
the heart, or even to recognize many of them, but there are many 
people who desire to know what these diseases are, their manifes- 
tations and especially what their outcome will be. For the in- 
formation of such individuals, rather than for the treatment of 
heart diseases, this chapter has been written. Then, too, there 
are some points in the treatment, especially in the diet, care 
and surroundings, that are practical and may be applied by anyone. 

CONGENITAL DEFECTS. 

Some infants are born with defects of the heart. The most 
frequent of these is a malformation, allowing the arterial and 
venous blood to mix, producing the so-called "blue child." The 
symptoms usually, though not always, appear soon after birth, 
the most striking of which is the blue color of the skin, due to an 
imperfect oxygenation of the blood in the lungs. The ends of 
the fingers are club-shaped; the breathing is always embarrassed; 
any exertion is impossible and development is prevented. 



346 GENERAL DISEASES. 

Half of these patients die before the end of the first two 
months of life, the great majority before sixteen months, and very 
few have been known to live thirty months. 

PERICARDITIS. 

Pericarditis is an inflammation of the pericardium or outer 
covering of the heart, and is almost always secondary to some 
other disease. Jts most frequent cause is acute articular rheu- 
matism (inflammatory rheumatism). 

Other causes are scarlet fever, diphtheria, typhoid fever and 
Bright's disease. A few cases cannot be traced to any cause. 

Symptoms. — Usually the first symptom is a sharp pain in the 
heart, but sometimes it is a chill. There is a feeling of discomfort 
in the region of the heart, and breathing becomes difficult; the 
temperature ranges from 101 degrees to 103 degrees; the pulse 
is rapid, and the patient restless. After a short time there is an 
effusion of serum into the pericardial sac, forming the so-called 
"water around the heart." This so interferes with the heart's ac- 
tion as to cause it to beat irregularly. There are other symptoms 
that can be detected only by a physician. The symptoms are not 
very marked ; sometimes they are almost entirely absent. The 
diagnosis is seldom made, except by an experienced physician. 
In every case of acute articular rheumatism the heart should be 
closely watched. 

Pericarditis runs a course of one to three weeks, occasionally 
longer, and relapse may occur, but the final outcome is recovery. 
If the pericardium becomes infected, from a wound or otherwise, 
and suppuration takes place a fatal result may be expected. 

Treatment. — Put the patient to bed at once and apply a 
blister over the heart. Opiates are often necessary to relieve 
pain, and digitalis to steady the heart; but these drugs cannot 
be given in these cases, except by a physician. Digitalis, al- 
though one of the most generally useful drugs in all affections 
of the heart, is absolutely dangerous in unskilled hands. 

If there is a large effusion into the sac, tapping by the sur- 
geon will be necessary. The patient should be restricted to a 
liquid diet, such as milk and broths and soft boiled eggs, and 
kept perfectly quiet. He should not be allowed to rise suddenly 
from bed until out of all danger. 



GENERAL DISEASES. 347 

ENDOCARDITIS. 

Endocarditis is an inflammation of the lining membrane of 
the heart. 

The disease is usually confined to the valves; and is generally 
due to an invasion of the germs of some infectious disease, such 
as acute articular rheumatism, diphtheria, erysipelas, scarlet fever, 
measles, pneumonia, typhoid fever or small-pox. The old idea 
that "the disease went to the heart" was not very far from cor- 
rect, though how it went was not understood. The majority of 
cases occur between the ages of five and fifteen years. 

Symptoms. — Endocarditis usually occurs in the course of 
one of the above mentioned diseases. There are no distinctive 
symptoms noticeable by the ordinary observer, but the patient 
becomes worse, the breathing is more difficult and rapid, there is 
an increase of restlessness, and the temperature goes up a de- 
gree or two. A valve murmur may be heard by the practiced ear, 
and it is upon this that the diagnosis rests. Injury to one or 
more valves occurs, which may or may not be permanent. 

The outlook as to life is good. Some cases recover com- 
pletely, but many a patient gets up with a heart permanently 
damaged. The injury is to the valves, and constitutes a val- 
vular disease, which will be mentioned later in this chapter. 
One attack is liable to be followed by another. 

Treatment. — The principal treatment is absolute rest. When- 
ever any part of the body is diseased it should be allowed to rest. 
Although we cannot put the heart to rest, by placing the patient 
in bed and keeping him perfectly quiet, we can reduce the num- 
ber of its beats by one-fourth. 

Often nothing else is required. Indeed, drugs have very 
little effect. 

The diet should consist of liquids and be easily digestible. 

MALIGNANT ENDOCARDITIS. 

This is a suppurative inflammation of the lining membrane 
of the heart and is a rare affection. It is characterized by chills 
and fever, as is the case in extensive suppuration in any part of 
the body. It occurs in connection with several of the infectious 
diseases, but most often with pneumonia, pleurisy, blood poison- 
ing, puerperal fever, rheumatism and gonorrhea. 

Symptoms. — Following, or occurring with one of the above 



348 GENERAL DISEASES. 

mentioned diseases, there are chills, fever and sweats, much re- 
sembling malaria; quinine, however, has no effect upon the tem- 
perature. Other symptoms are varied and not distinctive. Some- 
times the disease resembles typhoid fever, and again blood poison- 
ing. 

Death always results, usually in five or six weeks, but life may 
be prolonged for months. 

Treatment. — Treatment, of course, is useless, except to nour- 
ish the patient and prolong life as long as possible. Rest, stimu- 
lants and nourishing foods are indicated. Alcoholics may be 
given, also quinine in small doses. The evidently grave nature of 
the disease will preclude home treatment. 

VALVULAR DISEASES OF THE HEART. 

A valvular disease of the heart is a chronic affection of a 
valve following acute endocarditis. Valvular affections are of two 
kinds, known as obstructive and regurgitant. 

In obstructive lesions the opening of the valve is narrowed, 
obstructing the flow of blood. Such an affection is called a 
stenosis. 

In regurgitant lesions the valve is so weakened that it- fails 
to close entirely and allows part of the blood to flow back, or 
regurgitate. Such an affection is called a regurgitation or ah 
insufficiency. 

Either or both of these conditions may be found in any of 
the four valves of the heart, and more than one valve may be 
affected at the same time. The valves in the left side of the heart 
are the ones most likely to be attacked, since the left side has the 
hardest work to perform. Lesions of the mitral valve are more 
frequent than those of the aortic, but not as serious. Any valvu- 
lar disease places more work on the heart. 

Symptoms. — These affections give few marked symptoms for 
some time, it may be for years. The increased work required of 
the heart causes it to enlarge, just as severe exercise enlarges 
the muscles of the blacksmith's arm. As long as the heart's 
power continues to increase in proportion with the growth of the 
disease it is said to compensate, and there are few symptoms. 
Sooner or later there comes a time when compensation fails and 
the heart dilates, its walls becoming thinner. The symptoms are 
then plain and danger is at hand. These symptoms of enlarge- 



GENERAL DISEASES. 349 

merit and dilatation will be described. There are some general 
symptoms, such as palpitation, getting out of breath easily, dizzi- 
ness and dropsy, which should lead anyone experiencing them to 
have a careful examination by a competent physician. In these 
cases the sounds of the heart are so changed that the disease may 
be recognized by a trained ear. 

The prospects of recovery cannot often be determined. 
Much depends upon the mode of life of the patient, whether it 
be quiet or subject to frequent changes, either physical or mental. 
Disease of the mitral valve often continues for an average life- 
time. Recurring attacks (of endocarditis) make the outlook 
more grave. Death is usually preceded by dilatation with warn- 
ing symptoms. 

Aortic disease is a serious one. It is a condition in which 
sudden death is to be feared, yet the patient may live many years. 
Disease of the tricuspid valve is still more fatal, but it is ex- 
tremely rare. The valve diseases in children are much more 
serious than in adults. The impression given out by some phy- 
sicians that children outgrow valvular diseases is false. 

Any serious acute disease, especially of the lungs, is more 
serious if the patient already has a valve lesion. But these are only 
general rules. The prognosis of each case rests upon the condi- 
tions in that case, and upon the subsequent mode of life. 

Treatment. — Each case must be treated by itself and by a 
physician. A person with valvular disease should avoid over- 
exercise and excitement. He should not run, or walk rapidly, or 
climb stairs hurriedly. He should avoid extremes and passions 
of all kinds, especially fits of anger, and must lead an easy, quiet 
life, as free from sudden changes as possible, eating and sleeping 
regularly and avoiding exposure. When compensation fails medi- 
cinal treatment will be necessary. 

HYPERTROPHY OR ENLARGEMENT OF THE HEART. 

This is a condition in which there is an increase of the muscu- 
lar tissue of the heart, bringing about an increase in size, thick- 
ness of the walls, weight, force and efficiency. The walls are the 
seat of enlargement, the cavities having their normal proportional 
size. The weight increases from the normal weight of 1 1.8 ounces 
to from twenty-five to fifty ounces. The cause of hypertrophy is 
usually valvular disease, but it may be Bright's disease, aneurism, 



350 GENERAL DISEASES. 

disease of the capillaries or liver. It may or may not be accom- 
panied by dilatation. 

Symptoms. — As long as enlargement keeps pace with the 
force required to pump the blood through the body the symptoms 
are few. After a time the increased force of the heart produces 
an increased blood pressure in the vessels. We then have hard, 
throbbing arteries, palpitation, dizziness, headache, ringing in the 
ears, flushing of the face and a tendency to nose-bleed. The pulse 
is bounding and may be seen throbbing in the neck, the heart beat 
being very forcible and plainly visible. The prospects for re- 
covery in enlargement of the heart are those of the condition 
causing it. Of itself it is not a thing that threatens life. 

Treatment. — There is no drug that will have any effect what- 
ever. The cause only can be treated. 

DILATATION. 

Dilatation of the heart is a condition in which the cavities 
are enlarged, while the walls remain of normal thickness or, more 
often, are thinned. Usually there is also a fatty degeneration of 
the muscular fibers. The force of the heart is lessened. Dilata- 
tion is often the last stage of valvular disease, following hyper- 
trophy. It ma)' occur from any wasting disease, or from overex- 
ertion. In these cases it comes suddenly and death results quickly. 
Death from dilatation is the so-called "heart failure," that ends 
valvular disease. It is also seen in acute infectious diseases. 

Sometimes a child with broncho-pneumonia or diphtheria or 
typhoid fever is past the danger point and well on the road to 
recovery, when he is unwisely allowed to get out of bed and walk 
about the room, resulting in sudden collapse and death from 
dilatation. 

Heart failure is also a name that is used to cover many 
deaths, the cause of which is unknown. The heart gradually 
dilates and weakens, until sometimes it dilates past the point of 
contracting again, and life goes out. The process is usually 
slow, but may take place in a moment and from a very slight ex- 
ertion. 

Symptoms. — In acute cases there is sudden pain in the heart, 
shortness of breath, rapid, feeble pulse, collapse and death. In 
prolonged cases these symptoms appear, then disappear, to come 
again with renewed exertion. 



GENERAL DISEASES. 351 

There are general symptoms, such as dropsy, enlargement of 
the liver, short breath, congestion of the veins all over the body 
and fainting" spells. 

The result will be fatal. The only question is as to time. 
Dilatation means that the end is approaching. 

Treatment.— In acute cases there is no time for treatment, 
and if there were it would be useless. In prolonged cases the 
treatment must be by a physician. The patient should avoid all 
exertion and excitement. 

RUPTURE OF THE HEART. 

Rupture of the heart is rare, but it sometimes occurs. It 
takes place only when the heart has been weakened by dilatation 
or degeneration, and is then subjected to strain. There is sud- 
den pain in the heart, loss of breath, collapse and death. 
Obviously there is no treatment. This is another of the affections 
known as heart failure. 

DEGENERATIONS. 

These are conditions in which the muscular libers of the 
heart degenerate into lower structures. Fatty degeneration is 
most common ; others are fibroid, albuminoid, amyloid and cal- 
careous degenerations. As these conditions are so difficult of 
diagnosis as to often be overlooked, even by competent phy- 
sicians, it is useless to speak here of symptoms or treatment. 

PALPITATION. 

Palpitation of the heart is an unnatural, irregular or rapid 
beating of the heart, usually of nervous origin. The patient is 
painfully conscious of the palpitation, and often greatly alarmed. 
The disease is much more common in women than in men. It 
may be caused by anemia, indigestion, mental emotion, protracted 
illness, sexual excess, overwork, excitement or worry. Alcohol, 
tobacco, coffee or tea, in excess, may cause palpitation, especially 
in those of a nervous temperament. Cigarette smoking is a fruit- 
ful source of the disorder. 

Symptoms. — The unnatural beating of the heart is the chief 
symptom. 

This beating may be so rapid as to become a mere flutter, 
reaching a rate of two hundred per minute. The attack comes 



352 GENERAL DISEASES. 

without any apparent cause, lasts a few minutes, or, more rarely, a 
few hours, then passes away, leaving the heart normal until an- 
other attack. These paroxysms, at irregular intervals, may occur 
for years without serious harm. Accompanying them there is a 
"feeling of goneness" — weakness in the region of the stomach, 
and sometimes nausea. There are cases in which the only symp- 
tom is the occasional missing of a heart beat. The omitted beat 
may range from one in thirty to one in three. The patient notices 
it and is likely to be annoyed or alarmed by it. 

An abnormally slow heart may be found in epilepsy, cata- 
lepsy, hysteria, and several other affections. 

Treatment. — Rest and nourishing food are important ele- 
ments in the treatment. Sedatives, such as potassium bromide in 
fifteen-grain doses three times a day, are useful in nervous cases. 
When the patient is weak and anemic the following is good : 

Fowler's solution two drams. 

Glycerole of iron four ounces. 

Dose. — A teaspoonful after each meal. 

The elixir of iron, quinine and strychnia, in doses of a dessert- 
spoonful three times a day, will help to build up weak patients. 
Outdoor exercise and everything that will improve the general 
health will tend to prevent the attacks. During the attack the 
patient should be kept quiet, lying down. Small doses of bromides 
(ten grains), digitalis (one drop), or aconite (one drop), are then 
useful, but not necessary. These cases furnish subjects for the 
hypnotist and "Christian Scientist." 

ANGINA PECTORIS. 

Angina Pectoris is an affection, characterized by severe pain 
in the heart, and a sensation of impending death. Its cause is 
valvular disease, hypertrophy or disease of the arteries of the 
heart (coronary arteries). It is seen only in persons past middle 
age, and most frequently in women. The attack is brought on by 
physical exertion or mental emotion. 

Symptoms. — The principal symptom is pain, beginning in 
the heart and extending up into the neck and down the arms, 
especially the left arm. 

With the pain there is a sensation of oppression in the heart, 
shortness of breath, and an uncontrollable feeling that death is 



GENERAL DISEASES. 353 

at hand. The skin is pale and beaded with perspiration, and 
there is an expression of anguish in the face, which once seen is 
not forgotten. The attack lasts from a few minutes to half an 
hour, when the patient either recovers or dies. Another attack 
may come in a few months, or not for years. Hysterical patients 
sometimes have attacks of hysteria closely resembling angina. 

One-fourth of all cases die in the first attack. Others live 
a longer or shorter time, but some attack finally proves fatal. 
Any attack may be the last, but occasionally a patient lives to a 
moderately old age. 

Treatment. — The attack should be treated with morphine 
(one-fourth grain hypodermically), or nitrite of amyl by inhala- 
tion. Chloroform is useful, and hot applications should be used 
over the heart. Between attacks the patient must avoid all ex- 
posure, hurry, exertion and excitement, being careful to lead a 
perfectly quiet life and to eat no indigestible food. He should, 
however, take moderate exercise. Medicinal treatment, with a 
view to keeping off the attacks, may be given by a physician. 
It is well for the patient to carry the small pearls of nitrite of 
amyl — kept by druggists. The pearl should be crushed in the 
handkerchief, and the nitrite immediately inhaled at the begin- 
ning of an attack. 

DISEASES OF THE BLOOD AND VESSELS.— ANEURISM. 

Sometimes when the walls of an artery are diseased and sub- 
jected to a strain they give way without entirely rupturing, form- 
ing a bulb or sac in the course of the artery. This is called an 
aneurism. The same condition in a vein is called a varix, and the 
vein is said to be varicosed. 

The most common cause is the one just mentioned, a strain 
in a vessel already weakened by disease, but a violent strain may 
produce aneurism in a vessel previously sound. Any of the large 
arteries may be thus affected. 

Symptoms. — The symptoms vary with the location of the 
aneurism, and are not plain to the ordinary observer. 

Prognosis. — Aneurism of the aorta is fatal sooner or later, 
from perforation of the walls and hemorrhage. Aneurism of the 
arteries of the brain often gives way, causing cerebral hemorrhage 
(apoplexy). Aneurism of the other arteries may not shorten life. 

Treatment. — The treatment must be by the surgeon. The 

23 



354 GENERAL DISEASES. 

only drug reputed to have any effect whatever is iodide of potas- 
sium. 

VARICOSE VEINS. 

Varicose veins are veins that have enlargements or dilated 
portions. 

They are usually the superficial veins of the lower extremities, 
or the spermatic veins. They indicate a weak heart action, slug- 
gish circulation, or lack of tone in the vessel walls. 

Treatment. — There are two ways of treating varicose veins. 
One is the palliative method. As its name implies, it is temporiz- 
ing and palliative, not curative, and consists of the application 
of bandages, silk or elastic stockings, etc. It may slightly re- 
lieve the condition, but does not cure it. The other method is 
surgical, and consists of simply cutting down to the dilated vein 
and tieing it at seyeral points, or removing it entirely. This opera- 
tion is very easily performed, is not dangerous, and puts an end 
to the varicose vein. By the aid of cocaine, it may be done with- 
out even giving an anesthetic. 

ARTERIO SCLEROSIS. 

This is a disease of the arteries in which there is first an in- 
flammation, then the formation of alternate soft and hard spots in 
the vessel wall. The hard parts destroy elasticity, thus interfer- 
ing with circulation ; the soft parts give rise to aneurism, or rup- 
ture and hemorrhage. The caliber may be much diminished by 
thickening of the walls, and the vessel may be closed entirely by 
clots. In some cases the artery becomes a solid rod, shutting off 
all circulation and leading to gangrene. Arterio sclerosis is a 
disease of those past middle life, and is found more frequently 
in men. It is often hereditary. Some of the exciting causes are 
gout, rheumatism, lead poisoning, alcohol, syphilis and the over- 
exertion of athletes and acrobats. 

Symptoms. — In superficial arteries the disease may be de- 
tected by the dilated, hard, often bony feel of the vessel. It is 
difficult to compress, and rolls under the finger like a cord. 
Often the alternate hard and soft rings may be felt, giving the 
same sensation as the windpipe felt in the neck of a small animal. 
It is frequently accompanied by hypertrophy of the left side of the 
heart. Cerebral apoplexy, pulmonary congestion, angina, vari- 
cose ulcers and gangrene of the lower extremities are some of the 
serious complications directly resulting from this disease. 



GENERAL DISEASES. 355 

The prognosis is grave. If the disease is of syphilitic or gouty 
origin, treatment often produces good results; otherwise a fatal 
termination may be expected, though it be postponed for years. 

Treatment. — The only drug having any effect upon this dis- 
ease is iodide of potash, which should be given three times a 
day. It is well to begin with ten grains at a dose and gradually in- 
crease. Fifty, or even one hundred grains, three times a day can 
thus be given after a little with safety. The patient should live 
a quiet life, free from excitement and excesses of every kind. Any 
sudden exertion may lead to a fatal central hemorrhage. The 
first thing should be to find the cause — gout, syphilis, or what- 
ever it may be — then to treat that cause appropriately. Many 
cases reach a very serious condition before being recognized. In- 
deed, many are never recognized. 

ANEMIA. 

Anemia is a condition in which either the quantity or quality 
of the blood is materially below the normal. Of course, anemia 
follows a large hemorrhage. It also occurs in the later stages of 
wasting diseases, such as consumption, cancer and diabetes. 
These are only symptoms or results of other conditions and will 
not be described here, being treated elsewhere in this work. 
Anemia, as here referred to, is a certain disease known by phy- 
sicians as pernicious anemia. Chlorosis is also an anemia, but 
will be treated separately. 

The cause can seldom be found. The disease is most fre- 
quent in the old, although no age is exempt from it. Men are 
more often affected than women, but pregnant women seem quite 
susceptible. Fortunately it is a rare disease. 

Symptoms. — The disease begins as a weakness, weariness or 
languor, which gradually increases to such extreme debility that 
any exertion causes faintness. Finally the patient takes to his 
bed and is unable to rise. 

Both body and mind are torpid. The lips, gums and con- 
junctiva are pale, while the skin is a faintly yellowish or greenish 
white. Contrary to what might be supposed there is no emacia- 
tion, and very little weight is lost. 

Digestion is interrupted, and often there is nausea, vomiting 
and diarrhea. The principal change in the blood is not in the 
amount of blood, but in the decrease of red-blood cells. The 



356 GENERAL DISEASES. 

number may be reduced to one-fourth, one-tenth, or even one- 
twentieth of the healthy number. The amount of hemoglobin in 
each cell is not diminished. 

The prognosis is serious. Some cases improve under proper 
treatment, and recoveries do take place, but they are the excep- 
tions. 

Treatment. — Put the patient to bed and in place of exercise 
give massage. Good nourishing food and hygienic surroundings 
favor recovery. Beef juice, liquid peptonoids and peptonized milk 
are excellent foods. Of medicines, arsenic is the most useful. 
It is best given in the form of Fowler's solution, three times a 
day, beginning with five drops at a dose and increasing to twenty 
or thirty. This should be kept up for months. Iron should also 
be given, but its use is not as important as that of arsenic. 

Wyeth's glycerole of iron, Parke, Davis & Co.'s syrup of 
the chloride of iron, and Gude's "Pepto-mangam are excellent 
preparations. 

CHLOROSIS. GREEN SICKNESS. 

Chlorosis is an anemia met with in young women between 
puberty and twenty-four years of age, and it seldom occurs in 
anyone else. It is more common in blondes than in brunettes, 
and in the delicate than in the vigorous. Girls who menstruate 
early are most subject to it. Confinement, lack of exercise and 
continued emotional excitement are factors of its cause. 

Symptoms. — -The patient, who is nearly always a girl between 
the ages of sixteen and twenty, is weak and easily gets out of 
breath. The lips are pale and the skin has a yellowish or greenish 
pallor. Vertigo and palpitation of the heart are common. Men- 
struation is apt to be irregular, the patient missing periods. Some 
cases resemble the decline of consumption, but there is no cough. 
The blood is materially altered. The number of red-blood cells is 
reduced, but not as much as in pernicious anemia. The hemo- 
globin is usually reduced by one-half or more. The shape of the 
red cells is also changed. 

The prognosis, under proper treatment, is favorable. Res- 
toration to normal health may always be expected, but time 
— weeks or months — may be required. The disease should not be 
allowed to go on very long. In such cases development is inter- 
rupted and permanent depraved conditions of health established. 



GENERAL DISEASES. 357 

Treatment. — The patient should be put to bed and given 
plenty of nourishing food. Massage is a useful measure. A 
change of scene is beneficial, especially if it be to the seaside. 
Iron has an almost miraculous effect upon chlorosis. It should 
be given in small doses as directed for anemia. 

Arsenic is less useful, but should also be given, in the form 
of Fowler's solution, five drops three times a day, and gradually 
increase the dose to fifteen or twenty drops. 



CHAPTER VI. 



DISEASES OF THE LUNGS. 

By Louis C. Duncan, M.D. 

The two lungs, one on each side of the chest, are covered 
by a smooth, serous membrane, the pleura, which also lines the 

inner walls of the 
chest, providing smooth 
surfaces to avoid friction 
in the movements of the 
lungs in breathing. 
These two surfaces, the 
outer surface of the 
lungs and the inner sur- 
face of the chest wall, are 
usually in contact, leav- 
ing no vacant space; but 
they may be separated to 
form a vacancy known as 
the pleural cavity. Be- 
tween the lungs is the 
heart, and below them 
the diaphragm or midriff. 
The structure of the 
lungs is very delicate and 
complicated. To study 
it we begin at the trachea 
(windpipe). 

The trachea is com- 
posed of rings of cartilage, which keep it open. It extends down 
the middle of the neck and about four inches into the chest, 
where it divides into two branches known as the bronchi, which 
are similar to the trachea and divide and subdivide until their 
branches are too small to be seen with the naked eye. These 
small tubes are known as small bronchi, bronchioles, or capillary 
bronchi; each of the smallest terminating in a sac whose thin 

358 




Position and Relative Size of the Lungs. 



GENERAL DISEASES. 359 

elastic walls are pouched outward into little pockets called air 
vesicles, or air cells, having a diameter of but T j„ of an inch, 
and walls grVo °f an inch in thickness, between and around 
which is a capillary network of blood vessels. Here the venous 
is changed into arterial blood by discharging carbonic dioxide 
and absorbing oxygen in its stead. This exchange is probably 
facilitated rather than hindered by the extremely delicate mem- 
brane separating the air from the blood. The caliber of the 
capillaries is only a little greater than the diameter of a blood 
corpuscle, but they are so numerous as to constantly contain 
about four pints of blood. 

The lungs are estimated to contain about 725 millions of 
the air cells above described, with a total respiratory surface more 
than 100 times greater than the external surface of the body. Res- 
piration or breathing consists of the alternate expansion and con- 
traction of the chest by means of which air is drawn into and 
forced out of the lungs. Drawing air into the lungs is called 
inspiration, and expelling it from them expiration. The chief 
agent in breathing is the diaphragm, which is aided by the muscles 
of the chest. The movements of normal respiration take place 
from fifteen to eighteen times per minute, but disease, especially 
lung disease, greatly quickens them. The volume of air taken 
into the lungs and given out at each quiet normal respiration, by 
the average adult, is about 30 cubic inches, and is called tidal air. 
After each normal inspiration, from 100 to 130 cubic inches can 
be forcibly inspired, and after each normal expiration about 100 
cubic inches can be forcibly expelled, but after the most forcible 
expiration there always remain in the lungs from 100 to 130 cubic 
inches, called residual air. From this it will be seen that only a 
small part of the air in the lungs is subject to renewal at each 
inspiration, and that by forced inspiration the lungs may contain 
about 330 cubic inches. 

"It is important to remember that the lungs, even after the 
deepest expiration, always contain a large amount of air. In 
this way the diffusion of gases, between the air in the lungs and 
the blood gases, can go on continuously, with increase of the 
process at every inspiration. The vital capacity, the amount of 
air that can be forcibly expelled from the lungs by the average 
man of ordinary height, is 230 cubic inches, this capacity being 
greatest at about 35 years of age." (Landois and Sterling.) 



360 GENERAL DISEASES. 

Sighing consists of a prolonged and almost noiseless inspira- 
tion, followed by a sudden, noisy expiration. 

In hiccough there is a spasmodic contraction of the dia- 
phragm, causing a sudden inspiration, with a peculiar sound as 
the air rushes through the larynx. 

Coughing is a complex process : First there is a contrac- 
tion of the diaphragm as if for expiration, but the larynx is closed ; 
then, as the other muscles aid the diaphragm and the pressure 
becomes great, the larynx opens suddenly and the air is forced 
out with an explosive sound. 

Sneezing is like coughing, except that the air is forced out 
through the nose instead of the mouth. 

Function. — As already implied, the function of breathing is 
to supply the blood with oxygen, and carry from it carbon dioxide. 
The 30 cubic inches of pure air inspired at each breath contain 
about 21 parts, in every 100, of oxygen and a mere trace of car- 
bon dioxide, but that which is expired has only 16 parts of oxy- 
gen, and contains \\ parts of carbon dioxide. The oxygen is 
necessary to life ; the carbon dioxide is poisonous. A large quan- 
tity of water and some animal matter is also thrown out with the 

expired air. 

BRONCHITIS. 
(Cold in the Chest. Cold on the Lungs.) 

Bronchitis is an inflammation of the membrane lining the 
bronchial tubes. It is limited to the larger tubes and affects both 
lungs. Its principal cause is chilling of the body (taking cold). 
It may follow a cold in the head or throat. It is rare in the sum- 
mer and autumn ; most frequent in the late winter and early 
spring. It may accompany measles or la grippe. 

Symptoms. — There is a feeling of weight, soreness or tight- 
ness in the chest, with continued coughing. The cough is hard 
and dry in the beginning, gradually becoming looser. With the 
dry cough there is little expectoration, but when it loosens the pa- 
tient spits a yellow mucus. There is only slight fever (too degrees 
to 1 01 degrees). The disease usually lasts but six or eight days, 
but in the weak, debilitated and aged it may last several weeks. 
Some cases become chronic. There is seldom interference with 
the breathing, except in children, and there are no sharp local 
pains. 

In infants bronchitis may lead to pneumonia with fatal 



GENERAL DISEASES. 361 

results. In adults the prospects as to life are absolutely good. 
The worst that can happen is the disease may become chronic. 
Bronchitis does not tend, as some people think, to consumption. 

Treatment. — If possible, the patient should be put to bed. 
If this can be done, no other treatment is necessary, but many 
wish to keep up, or even to attend to their business, and for these 
medical treatment is needed. An application of mustard or tur- 
pentine to the chest will, in many cases, effect a cure. Care 
should be used not to blister. One of the best medicinal reme- 
dies is the citrate of potash. A tablespoonful of the solution 
should be given every two hours. Sweet spirits of niter, thirty 
drops every three hours, will promote perspiration and loosen 
the cough. 

If the cough is very harassing, give the following: Syrup 
of white pine compound, four ounces ; codeine, eight grains ; shake 
thoroughly and give a teaspoonful every hour until the cough is 
relieved. 

If the cough does not loosen readily and an expectorant is 
wanted, give a teaspoonful every three hours of the following: 
Chloride of ammonia, two drams; syrup of wild cherry, three 
ounces. 

Do not put a poultice upon the chest. Hot drinks and a hot 
footbath just before retiring are old and meritorious measures. 

CHRONIC BRONCHITIS. 

When bronchitis continues for several weeks it is said to 
be chronic. 

Chronic bronchitis may be caused by a succession of colds, or, 
it may be, by an extension of acute bronchitis. It also follow T s 
measles, la grippe and pneumonia. Other causes are valvular 
disease of the heart and chronic Bright's disease. 

Symptoms. — The most prominent symptom is the cough. 
There is more or less coughing at all times, but there are spells 
of continuous coughing, caused by an accumulation in the bron- 
chial tubes. These spells usually come on in the morning, but 
may come in the night or at any time. There is considerable 
expectoration of a thick, stringy, yellowish substance said to be 
muco-pnrulent — a mixture of mucus and pus. It often contains 
greenish masses. In some cases there is hardly any expectoration. 
Usually there is no fever, and there is but slight interference with 



362 GENERAL DISEASES. 

the breathing. The appetite remains good, and there is but little 
loss of weight. In old persons the symptoms almost disappear 
in summer, but come on again each winter. 

The prognosis is favorable as to life, but unfavorable as to 
recovery. 

Long-continued cases are frequently complicated with 
asthma. In the aged the disease may prove fatal. 

Treatment. — The patient should be warmly clothed, with 
wool next the skin, and should take particular care to keep the 
feet warm and dry. Every cold makes the condition worse. 
If, in the early stages, the patient can go to a warm climate, he 
will recover without any other treatment. Of medicinal remedies, 
perhaps the best is creosote. At first one drop of it should be given 
three times a day, then the dose should be slowly increased to 
five drops. It may be given in pill form, or in red wine well 
diluted. Inhalations of the vapor are often useful. Place a few 
drops of creosote in a cup of water, heat over an alcohol lamp and 
inhale the vapor. Atomizers do no good. If an expectorant is 
needed give a teaspoonful every four hours of the following: 
Carbonate of ammonia, three drams; syrup of tolu, four ounces. 

Strychnia is useful in all cases. Begin with one-sixtieth of a 
grain and very gradually increase to a twentieth of a grain three 
times a day. 

Quinine, in small doses, and cod liver oil are excellent reme- 
dies. The climates suitable to one with chronic bronchitis are 
those of Georgia, Florida, New Mexico and the coasts of the 
Mediterranean. 

ASTHMA. 
(Bronchial Asthma.) 

Bronchial asthma is a disease of the bronchial tubes charac- 
terized by attacks of labored and difficult breathing. There is a 
temporary, spasmodic contraction of the tubes that causes gasping 
for breath. The cause of this contraction is not known. The 
disease is frequent in children, more frequent in men than in 
women, and those of a nervous temperament are more prone to it, 
An attack may be brought on by exposure, taking cold, overexer- 
tion, indigestion and similar causes, and although it may come at 
any time it is most frequent in the evening. 

Symptoms. — The patient can get his breath only with diffi- 



GENERAL DISEASES. 363 

culty, the amount of this difficulty depending upon the severity of 
the attack. His face is pale and anxious, or it may be bloodshot. 
The inspiration is long drawn and the patient seems unable to get 
enough air into the lungs, but often he has even greater difficulty 
in expelling it; and there is a whistling, wheezing sound as it 
passes in and out. The patient makes idolent muscular exertions 
to breathe ; the muscles of the neck and chest are contracted and 
the abdominal muscles are hard; his chest moves but slightly; 
he sits upright, or leans a little forward, and seems to be suffocat- 
ing, but in spite of all his efforts the breathing is not accelerated. 
All the phenomena are very distressing to behold. The attack 
lasts from one to three or four hours, and may terminate with a 
fit of coughing, but coughing is not a prominent symptom and 
often does not occur. The patient soon learns to recognize the 
coming of an attack. Between the attacks the health is likely to 
be good. Asthma is very distressing, but not fatal. Some cases 
grow worse with age ; others improve, then entirely recover. A 
cure is possible in many cases. 

Treatment During the Attacks. — The patient should carry 
pearls of nitrite of amyl, and when the attack comes crush one in a 
handkerchief and inhale the drug. 

A quarter of a grain of morphine, hypodermically admin- 
istered, is the best remedy, but it involves the danger of causing 
"the morphine habit" if often repeated. Chloroform or ether may 
be used by inhalation. 

Most of the patent asthma cures contain niter and stramo- 
nium leaves. 

Anyone can prepare them. Add all the saltpeter to a pint of 
water that it will dissolve. In this solution soak strips of common 
blotting paper, then dry them thoroughly. Burn these on a dish 
covered by a large paper cone, and inhale the vapor. It very often 
gives great relief. It may be improved by adding the dried leaves 
of the stramonium datura (common jimson weed or thorn apple). 

Treatment Between the Attacks. — Y\ nen the cause is undis- 
coverable, as it frequently is, one of the following may be given : 

Tincture grindelia robusta three ounces. 

Tincture convalaria one ounce. 

Water nine ounces. 

Mix and give a teaspoonful three times a day. 



364 GENERAL DISEASES. 

Tincture grindelia robusta three drams. 

Tincture belladonna two drams. 

Iodide of potash five drams. 

Water enough to make four ounces. 

Mix and give a teaspoonful three times a day. 

The patient should wear warm clothing, keep his feet dry 
and avoid exposure and taking cold. Cold and moist climates 
and high altitudes are generally harmful. Low altitudes and 
warm, dry climates are best suited to asthmatics. Lower Califor- 
nia and Egypt are ideal places for those thus afflicted. 

PNEUMONIA. 

There are tw r o varieties of pneumonia, broncho-pneumonia, a 
disease of infants, and the ordinary pneumonia, seen both in chil- 
dren and adults. The latter is variously known as pneumonia, 
pneumonic fever, lung fever, lobar pneumonia, fibrinous pneumo- 
nia and croupous pneumonia. We will here speak of it simply as 
pneumonia or croupous pneumonia. 

It is an acute, infectious inflammation of the lungs, affecting 
the lung tissue proper as well as the air vesicles and bronchial 
tubes. It is usually confined to one lung. There is no longer 
any doubt that its cause is a specific germ, the bacillus lanceola- 
tus, discovered by Surgeon-General Sternberg of the United 
States army in 1880. It enters the lungs with the breath, is fre- 
quently found in the mouths of healthy people and may be intro- 
duced into the lungs of such persons without injury, for if one 
be in good health and in no way weakened or lacking in vitality 
the germ, on entering the lungs, is destroyed. But when the body 
is exhausted by fatigue or chilled by cold, or its vitality is in any 
w r ay materially lessened, even for a short time, the lungs seem to 
have no power to resist or throw out the germs, hence, finding 
lodgment there, they multiply at a marvelous rate and produce 
pneumonia. 

That cold is an important factor in bringing on the disease is 
shown by the fact that most cases occur in the winter or early 
spring. It is usually seen in but single cases, but pneumonia epi- 
demics sometimes occur. One attack does not prevent another, 
but renders its victim more susceptible to future attacks. The 
robust and vigorous seem to be more subject to it than the weakly 
and delicate, but probably this is because they are less careful about 



GENERAL DISEASES. 365 

exposure and fatigue. Children of from three to ten years seem 
to be favorite subjects of attack, for it occurs oftener in them than 
those of any other age, although it is quite common in the old 
and feeble. The lower lobes of the lungs are most often affected 
and the right one more frequently than the left. It may be inter- 
esting in this connection to notice that consumption usually be- 
gins in the apex of the left lung, and that bronchitis affects both 
lungs. 

Symptoms. — An attack of pneumonia is divided into three 
stages, depending upon the condition in the lungs and the ex- 
ternal symptoms. 

The Stage of Congestion is the first, and lasts about twenty- 
four hours. The very minute blood vessels surrounding the air 
vesicles are overfilled with blood and there is some exudation of 
blood into the vesicles themselves. This stage almost invariably 
begins with a severe chill, though in children it may begin with 
vomiting or convulsions. There may or may not be headache 
and a feeling of discomfort a day or two before the chill. 

Following the chill there is high fever — 103 degrees to 105 
degrees — and the pulse is full and strong, with from 100 to 120 
beats per minute. The respiration is from 40 to 60 per minute — 
a rate more rapid than in most other diseases. The face is flushed, 
the cheeks red and the eyes bright. Very soon in the side of the 
chest there is severe pain, aggravated by deep breathing, and 
there is a cough, dry and hard at first, but becoming looser, with 
expectoration in the later stages. 

The Stage of Consolidation comes next and is sometimes 
called the stage of red hepatization. The air vesicles and finer 
bronchial tubes are so filled with cells, serum and a tenacious 
substance, known as fibrin, that the part becomes a solid mass. 
The lobe affected is said to be solidified, and has the appearance of 
a piece of liver — hence the name, hepatization. The lung tissue 
is swollen and inflamed, but in this stage the cough is looser and 
there is the typical expectoration of pneumonia — a sticky, reddish 
or brownish-red mucus known as "brick-dust" or rusty expec- 
toration. 

In some grave cases the sputum is watery and dark purple 
in color, resembling prune juice, and known as "prune juice ex- 
pectoration." The rusty sputum generally appears in from one 
to three days after the attack, but may not come until the tenth 



366 GENERAL DISEASES. 

day, or even later, and then be only small in amount. In rare 
cases it does not occur at all. (In old persons the temperature 
may be but little above normal and the respirations but from 
24 to 30 per minute.) 

The other symptoms continue, the rapid breathing becomes 
labored and the temperature remains high. This stage lasts from 
four to nine days and ends in a crisis; that is, the temperature 
suddenly falls to normal and the patient seems much better. 

Stage of Resolution, or Gray Hepatization. This is the stage 
of recovery, or death. The substance in the air vesicles is softened 
and in the cases that recover is absorbed, but in those that are 
fatal it becomes purulent. The temperature should fall to normal, 
or below, and there should be free perspiration, the breathing 
becoming easier and the patient seeming better in every way. 

From this time recovery is rapid, and in from four to six days 
should be complete. 

But the cases do not all run such a typical course. The stages 
often merge into each other, and two stages may be present at the 
same time. The temperature and rate of breathing are highest in 
children. In aged people many prominent symptoms are absent. 
Fever sores (herpes labialis) on the lips are common. In some 
cases there are typhoid symptoms with delirium. 

When a case goes on to death, the breathing grows faster 
and more difficult, until the patient literally gasps for air; expec- 
toration is scanty or entirely lacking; the face is first blue, then 
pale ; the skin grows cold and clammy, and the strength fails 
rapidly; there is loss of consciousness, and often there is low de- 
lirium. Death takes place from heart failure, or by suffocation 
from filling up of the lungs. The fatal case usually runs its course 
in less than ten days. 

Complications. — The complications are empyema, abscess of 
the lung, gangrene, consumption, pleurisy, endocarditis and peri- 
carditis. 

One case in every five dies, even with the best treatment, 
and in the aged and intemperate the percentage of deaths is yet 
greater. Children usually recover, even when desperately ill, the 
mortality rate in those under five years of age being less than one 
in twenty. The young and vigorous adult, with seemingly mild 
symptoms, sometimes dies suddenly. The prospect depends 
somewhat upon the amount of lung tissue involved ; the order of 



GENERAL DISEASES. 367 

gravity being one lobe, two lobes, both lungs and the whole of 
both lungs. In the latter case death is the invariable result. Most 
cases end definitely, either in complete recovery or in death. 

Treatment. — As yet there is no specific cure for pneumonia. 
The disease usually runs its course and cannot be "broken up" 
or shortened by drugs. The object of treatment, then, is to lessen 
the intensity of the disease, stimulate the patient until the crisis is 
past, stimulate the lungs and heart when necessary, nourish and 
nurse the patient, and treat other symptoms or complications as 
they arise. 

Fifty years ago bleeding was always the practice in pneumo- 
nia, but it has been entirely abandoned and the death rate, as 
shown by reliable statistics, is no greater. Instead of blood-letting, 
which is weakening, the foundation of the present treatment of 
pneumonia is nourishment and stimulants. The patient should 
have plenty of good, easily digestible food. 

A suitable diet is one and a half to two pints of milk, two or 
three eggs, and meat broths each day. Alcoholic, stimulants are 
needed almost from the first. There is hardly any other disease 
in which they are so useful. A half-ounce of whisky or brandy 
may be given every three to six hours, and, for a short time, it 
may be given oftener than that. About the time of the crisis 
strychnia is needed. In weak patients it may be needed through- 
out the whole course of the disease. One-fortieth of a grain may 
be given every four hours. 

To relieve the pain, codeine, in one-half grain doses every 
four hours, is good. Poultices should not be used upon the 
chest, for they do harm instead of good. An application of well- 
diluted turpentine is often useful. 

Expectorants are not needed until the stage of resolution 
arrives. During that period five grains each of ammonia carbo- 
nate and iodide of potassium may be given every three hours. 
The fever in pneumonia is not dangerous in itself, but when a 
temperature of 104 is reached it should be reduced by sponging 
with tepid water. The room in which the patient is kept should 
be well ventilated both day and night. Lack of sufficient oxygen 
in the blood is a feature of the disease, and it should be supplied 
as freely as possible. In the large cities oxygen is used as part of 
the treatment, and with excellent results. 



368 GENERAL DISEASES. 

BRONCHO-PNEUMONIA. 

Broncho-pneumonia is an inflammation of several small 
areas, or parts, of the lungs, and is practically the same disease as 
capillary bronchitis. 

Although almost entirely a disease of children, and, in the 
great majority of cases, occurs in those of less than three years, it 
is also found in old age. It is not caused by any one class of 
germs or microbes. It may occur as a separate disease, but it very 
often follows one of the infectious diseases, especially measles, 
diphtheria or whooping cough. 

It also, though rarely, follows scarlet fever, typhoid fever and 
bronchitis. In the aged it may follow la grippe, typhoid fever or 
Bright's disease. Like croupous pneumonia, it is a disease of 
winter and spring. It can hardly be called contagious, though we 
occasionally see two cases in one family. 

Symptoms. — The symptoms are not well marked and plain 
like those of croupous pneumonia. In the course of, or during 
convalescence from measles, diphtheria or whooping cough, there 
arises a cough, with fever from 101 degrees to 103 degrees, and 
the breathing becomes very rapid. This rapidity of breathing is a 
diagnostic symptom. It may range from 60 to 100 per minute, 
and the lack of sufficient air in the lungs is very apparent and dis- 
tressing. 

The cough is continuous and painful, but there is no expec- 
toration. 

There is great weakness, which increases to profound pros- 
tration, and the face becomes purple (cyanosis) from lack of suffi- 
cient oxygen in the blood. Death may occur in less than twenty- 
four hours, but usually the symptoms continue from one to three 
weeks, then disappear gradually, not suddenly, as in croupous 
pneumonia. The temperature varies considerably, frequently 
reaching 104 degrees or 105 degrees. Since the temperature of 
all diseases goes higher in children than in adults, a high fever in 
a child in such cases is not of as grave import as it would be in an 
adult. The diagnostic symptoms are : Acute onset, continued 
high fever, very rapid breathing, prostration and cyanosis. Death 
comes from heart failure. 

Broncho-pneumonia is a serious and treacherous disease. In 
hospital practice the mortality is from 30 to 50 per cent. In 
private practice better results are obtained, but even here from 



GENERAL DISEASES. 369 

i o to 25 per cent of those who take the disease die. The younger 
the child the greater the danger, but a case, in which the fever is 
high and the child seems desperately sick, frequently recovers. 
On the other hand, those with a low but fluctuating temperature 
and seemingly mild symptoms may die suddenly. There is no 
other disease in which the outlook is so uncertain and the fate 
of the patient seemingly so subject to caprice as this form of 
pneumonia. One attack does not prevent another. 

Treatment. — As in croupous pneumonia, the foundation of 
the treatment is nourishment and stimulants. The disease runs a 
certain course and we must maintain the bodily strength until the 
dangerous period is past and reaction comes. 

The entire trunk, back and all, from neck to navel, should 
be wrapped in cotton batting and covered by a closely fitting 
jacket of oiled silk or oiled linen, and it should be worn until 
recovery. This is much better than heavy poultices, which impede 
the already difficult breathing. If a counter-irritant is wanted, 
and it often is, apply to the chest a paste of one part of mustard 
to six parts of flour or meal, or a cloth wrung from hot water 
containing a little turpentine. Although the modus operandi of 
these things is not exactly known, all agree that they do good. 

In children all expectorants, emetics, and such things as 
squills, ipecac and antimony are far better omitted. Their only 
effect is to disturb the stomach. Stimulate from the beginning, for 
which purpose whisky or brandy is preferable ; from one-half an 
ounce to two ounces of either one may be given daily to a child 
one year old. Dilute with eight parts of water. Strychnia is 
necessary when there is great prostration. A child one year old 
should have one-two hundred and fiftieth of a grain every four 
hours. These stimulants are most needed when the temperature 
is low or falls suddenly. More of each may be given for a short 
time, and, of course, a larger dose to an older child. 

For the fever do not give any of the antipyretics, as antipyrin, 
acetanilid, phenacetin, or even quinine. They do no good in these 
cases and often do harm. High fever is not as serious a thing in 
a child as in an adult. Not until the temperature reaches 105 
degrees is there occasion for treatment of the fever. Then take 
equal parts of alcohol and water (temperature 80 to 85) and sponge 
the whole body from ten to twenty minutes. This will reduce 
the temperature and quiet the restless child more safely than any 

24 



370 GENERAL DISEASES. 

or all drugs known. If the temperature is very high it may be 
reduced by frequent sponging with water as hot as can be borne. 
It may also be reduced by a cold pack, or a cold bath. While both 
methods have their advocates, it is thought by many that the hot 
water is the better and safer agent 

The cough is best treated by inhalations of creosote vapor. 
These may be taken by placing a small sponge at the end of the 
spout of an ordinary teakettle, in which there is water hot enough 
to produce a little steam, dropping a few drops of creosote on the 
sponge, then allowing the child to inhale the steam as it comes 
through the sponge, care being taken that the steam shall not be 
too hot. 

Do not give many drugs. They are not needed. There is 
great danger, in any disease, of giving a child too much rather 
than too little medicine. 

CONSUMPTION. 

Consumption of the Lungs. Tuberculosis of the Lungs. Pulmonary Consumption. 
Phthisis. Pulmonary Phthisis. 

Consumption of the lungs is an infectious disease due to the 
lodgment in the lung of a specific germ, the bacillus tuberculosis. 
The disease is characterized by the formation of tubercles in the 
lungs, the destruction of lung tissue and a general wasting of the 
body. It is so widespread and fatal that in the temperate zone 
one-tenth of the entire population dies of it. In the torrid and 
frigid zones it is almost unknown. 

It is an established fact that the cause of consumption is the 
bacillus tuberculosis, a minute vegetable germ discovered by 
Koch in 1882. The disease tuberculosis, which it produces, at- 
tacks any and all parts of the body, consumption, or tuberculosis 
of the lungs, being but one form of the disease. The germ enters 
the body in one of two ways. In by far the greater number of 
cases it is inhaled with the air. Tubercular patients spit upon 
floors, walks, and elsewhere, and as the sputum dries the germs are 
blown about in the air as dust. In some cases it enters the stomach 
in the milk of cows affected with tuberculosis. 

If these statements are true, the question at once arises: 
"Why do not all people have tuberculosis?" In every community 
there are patients spreading the germs all the time, and it would 
seem miraculous that any of us escape. W T hile the germ is the 



GENERAL DISEASES. 371 

real cause of the disease, there are many factors that go to make 
for it a suitable lodging place in the lungs. It was only the seed 
sown on good ground that "brought forth fruit, some an hundred- 
fold, some sixtyfold, some thirtyfold." So with the germ, which 
may be considered the seed of tuberculosis. When it enters the 
lung of a person who i.s strong and vigorous, and has no tendency 
to the disease, it is destroyed ; but when it enters the lung of a per- 
son susceptible, it finds a suitable soil, remains, multiplies at a 
marvelous rate, and produces the disease. 

The factors which make up the tendency to consumption will 
now be given in the order of their importance. 

(i) Heredity, by which we mean a weak or peculiar cell 
structure, transmitted from parent to child. Its influence in this 
disease has long been recognized, and is more potent when both 
parents are affected. If but one parent has the disease the chil- 
dren most resembling that parent are more liable to it. Very 
many cases are not hereditary. 

(2) Age. — This has much to do with liability. Although 
no age is exempt, nearly all cases occur between puberty and 
thirty, and most cases occur between the ages of eighteen and 
twenty-live. It is likely to appear a year or two earlier in women 
than in men. 

(3) A delicate constitution favors the lodgment and multipli- 
cation of the germs. ' 

(4) Cold and damp localities and climates subject to sudden 
change show more cases than those with the opposite conditions. 

(5) Insufficient nourishment. 

(6) Persons with poorly developed lungs, as shown by nar- 
row or flat chests, are good subjects. 

(7) Race. — No race is exempt, but the colored race and 
the American Indian are peculiarly susceptible. 

(8) Chronic bronchitis. 

(9) Sex. — Women are more susceptible than men. 

(10) Exposure to cold and wet. 

(11) Measles and other infectious diseases of that class. 

(12) Occupation. — All confining or indoor occupations ex- 
ert a tendency to bring on the disease in those having hereditary 
or other tendency; and work attended by irritating dust is also 
a factor, as the work of masons, miners and metal polishers. 

Except to those having a tendency to the disease, houses that 



372 GENERAL DISEASES. 

have been occupied by consumptives are not specially dangerous. 
A person knowing himself to be liable to the disease should not 
live in such a house until after it has been thoroughly disinfected, 
and it is wise to take this precaution in any case. Burning a little 
sulphur in a room is not all that is needed. (See department on 
Disinfection.) 

The disease may be directly communicated from one to an- 
other, but this is rare. A person of a consumptive tendency should 
not nurse a consumptive patient. 

Symptoms. — Consumption commonly begins with a short, 
dry, hacking cough, which is most noticeable on going to bed at 
night, and just after rising in the morning. At hrst the cough 
is irritating and there is no expectoration. A peculiar sallow, or 
grayish, pallid complexion is early noticeable. 

This is often seen, in persons having the hereditary tendency, 
before the disease appears, and the doctor is able to say that such 
a person will have consumption. There is a loss of strength and 
weight, but the patient remains in good spirits ; yet, because of 
a tired feeling, he does not like to rise early in the morning. He 
is easily fatigued, and feels unequal to his usual work. 

Very early the pulse is quickened to ioo, or more, and there 
is fever in the afternoon and evening, the temperature rising 
gradually till evening, when it reaches 101 degrees to 103 degrees, 
then falling to normal during the night. 

When the fever is highest the eyes are bright, and the cheeks 
are flushed. The patient takes cold easily, and each attack is more 
severe. Very frequently there are attacks of pleuritic pain in the 
side of the chest. 

The weight steadily decreases, and the loss of flesh becomes 
noticeable. The bones are prominent and the cushions of fat on 
the ends of the fingers disappear. The cough, which was dry, be- 
comes looser, and there is expectoration, which becomes more 
and more plentiful. At first it is frothy, then muco-purulent ; fre- 
quently streaked with blood. In about half the cases there is 
spitting of blood. Hemorrhage from the lungs may occur at any 
time. Digestion is usually deranged, diarrhea is frequent in the 
later stages, and, as the disease progresses, the cough becomes 
more frequent and harassing. The sleep is broken and unrefresh- 
ing, the appetite fails, the patient grows weaker and weaker, and 
diarrhea increases the general weakness. He gets out of breath 



GEXERAL DISEASES. 373 

very easily and, in some cases, there are alarming attacks of 
dyspnea, in which he literally gasps for air. Yet. through all he 
remains cheerful and hopeful. There are periods of temporary im- 
provement, in which he feels so much better that even the friends 
may hope for recovery. In the last stages the cough is continuous, 
the appetite gone, the body wasted to a skeleton, the breathing 
very rapid and shallow, and the lower limbs swollen and painful. 

Death may come unexpectedly, while the patient is feeling 
better than usual, or after a gradual decline of a day or two. 
It is usually peaceful. 

Prognosis. — If the disease be early recognized and the pa- 
tient removes to a suitable climate, observes hygienic rules and 
pursues a vigorous course of treatment, recovery is possible ; other- 
wise, the best that can be hoped for is to delay as long as may be 
the fatal termination. If treatment be given a person having a 
tendency to consumption, but in whom it has not yet appeared, 
the disease may usually be prevented. Unfortunately, when con- 
sumption has reached the stage at which it is easily recognized, it 
has reached the point at which it is incurable. 

Prevention. — The prevention of consumption is of more im- 
portance than the cure, because, when the disease has once se- 
cured a good foothold, it is very doubtful if a cure is possible. 
Perhaps a majority of those who die of consumption know, before 
it appears, that they have a predisposition to the disease. They 
may also know that it is only during the few years between eight- 
een and twenty-five that they are very liable to be stricken. 
Knowing these things and that by preventive measures and care- 
ful living the dread disease may be avoided, it is wonderful that 
the prospective victim does not put forth every effort, during those 
years, to avert it. When he is once in its clutches, he will sacrifice 
time, money and opportunity, and grasp at every straw that 
promises help, but all to no avail. By putting forth proper efforts 
during the years of susceptibility he would be likely to escape and 
be enabled to consider himself safe the remainder of his life. 

The person subject to consumption should, if possible, first of 
all go to a suitable climate — one that is dry and uniform. The 
altitude should be moderately high — from 2,000 to 4,000 feet — 
yet, some low-lying regions are good, and sea voyages are bene- 
ficial. The best American climates, in the order of their merit, are 
as follows: 1. Lower New Mexico and Arizona. 2. Colorado, 



374 GENERAL DISEASES. 

Northern New Mexico and Western Kansas. 3. Southwestern 
Texas and Lower California. 4. Montana and Wyoming. 5. 
Western Carolinas. 6. Florida and the Gulf States. 

The worst climate for a consumptive is that of the North 
Atlantic States, being cold, moist and subject to great changes. 

The residence should be located on high ground and be free 
from all dampness. Plenty of fresh air is essential, and the rooms 
occupied should be accessible to sunlight throughout the day. 
There should be free ventilation by day, and still more by night; 
and it must be secured without draughts. An outdoor life is to 
be recommended, if it be possible. At any rate he should be out- 
doors much of the time, and take plenty of outdoor exercise, but 
avoid overexertion and exposure. He should bathe daily in tepid, 
not cold, water ; and he should dress warmly, with wool next the 
skin, summer and winter, day and night. The feet must be pro- 
tected against both dampness and cold. 

Food should be abundant and nutritious. Meats of all kinds 
should be eaten freely. Fats and rich broths are very useful. 
Milk and cheese are good, and cream is still better. Alcoholic 
stimulants are not necessary, and should be avoided, unless the 
disease actually appears or seems to be appearing. 

Breathing exercises are highly beneficial, as they develop the 
lungs and chest and so give increased vitality. They should be 
practiced several times daily. Stand erect, with the shoulders well 
back and the breast prominent; take a full breath, then slowly 
raise the arms above the head and draw in as much air as possible, 
then expel it, allowing the hands to drop by the sides. Repeat 
these movements about ten times a minute, and continue them 
for several minutes. If these exercises be continued persistently 
the chest measure and expansion can be permanently increased. 
They are especially beneficial to young persons, to whom they 
are recommended. Every cough should be watched and, if it 
hangs on, or if from any cause consumption isThought to be pres- 
ent, no time should be lost before consulting a physician and 
adopting more vigorous measures. 

Treatment. — When the disease first appears, but has not pro- 
gressed too far, treatment is beneficial and may be curative. If 
possible, the patient should go to one of the climates recom- 
mended and observe all the rules of health just given, for they ap- 
ply as well to the primary stages of the disease as to the tendency. 



GENERAL DISEASES. 875 

Plentiful feeding is especially necessary. In some hospitals for 
consumptives, feeding is the only treatment. The patient is fed to 
satiety, then encouraged to eat still more, as often as five times 
a day, and good results are obtained. Alcoholic stimulants are 
now useful. Half an ounce of whisky, with meals, improves diges- 
tion and increases the appetite, but two ounces a day will be just 
as useful as a larger quantity, probably more so. It may be com- 
bined with milk and cod liver oil. This oil has long been given 
and is, no doubt, useful, but more as a food than as a medicine. 
It should be taken pure if possible, a tablespoonful morning and 
evening. The various emulsions, wines and cordials of the oil are 
poor substitutes, and should be taken only when the pure oil dis- 
turbs the stomach. Many of them are frauds and contain almost 
no cod liver oil at all. 

Tyson gives cod liver oil in the following manner: ''Place 
in a wineglass a tablespoonful of whisky and overlay it with the 
same amount of the oil. Toss it into the back part of the throat 
and it is swallowed with great facility, nothing being tasted but a 
pleasant residue of whisky." 

The whisky not only disguises the taste of the oil, but also 
favors its assimilation. 

Creosote is a later remedy for consumption. It relieves cough 
and expectoration and, in the early stages of the disease, may be 
really curative; at least, it comes as near that as anything now 
known. It is conveniently put up in one grain pills. One / of 
these may be given after each meal, and the dose gradually in- 
creased to five or six three times a day. It is the large dose that 
does good. 

Iron and arsenic are useful in all cases. They may be com- 
bined as follows : 

Arsenic, Fowler's solution two and a half drams. 

Glycerole of iron four ounces. 

Give a teaspoonful half an hour after meals. 

Strychnia is valuable as a stimulant and tonic. Give from 
one-fortieth to one-thirtieth of a grain three or four times a day. 
Any of these drugs must be given for weeks, or months, to obtain 
much benefit. Of course, they should not all be given at the same 
time. In some cases one, in other cases another, is the best 
remedy. 



376 GENERAL DISEASES. 

In the later stages all we can do is to treat the various symp- 
toms, keep up the patient's strength, and delay the dread end as 
long as possible. All- the measures above named are still useful. 

Cough. — For the cough, creosote, as given above, is the best 
remedy. Later it can only be controlled by opiates; at first, co- 
deine, one-half grain, then morphine, one-fourth grain. 

Fever. — The fever of consumption needs no special treatment. 

Night Sweats. — Night sweats may be controlled by either 
one-sixtieth of a grain of atropine or twenty grains of camphoric 
acid (in capsules) at bedtime. 

Diarrhea. — The subnitrate of bismuth, in ten grain doses, is 
the best remedy. Later it may be combined with opium (one 
grain) or morphine (one-eighth grain). 

Constipation. — -Castor oil is the safest laxative. Do not give 
purgatives. 

Hemorrhage. — Hemorrhage from the lungs is very alarm- 
ing, but it usually stops of itself and, from its situation, we can 
do little for it. Put the patient to bed at once, with the shoulders 
elevated, and apply ice to the chest over the seat of the bleeding, if 
this be known. The domestic remedy, feeding common salt to 
the patient, is also useful, but is not as good a remedy as ice, ap- 
plied externally. If the hemorrhage persists a physician should 
be called. 

Serum Treatment of Consumption. — In 1890, Koch of Berlin 
announced the discovery of a substance, tuberculin, derived from 
the tubercle bacillus, and claimed it to be useful in the treatment 
of tubercular disease. 

For a time it was thought that the long-sought "consump- 
tion cure" had been found. Although this tuberculin proved to 
be of no value, it was a step in the right direction. A somewhat 
similar substance has since been discovered for the prevention and 
cure of diphtheria, and is an undoubted success. (See article on 
Diphtheria.) It is believed by many that every germ disease has 
within itself the means for its own cure, but this remains to be 
demonstrated. Vaccination against small-pox is an exemplifica- 
tion of this idea, and the Pasteur treatment of hydrophobia is an- 
other. 

Many investigators are earnestly working upon the tubercu- 
losis problem, and it may be confidently predicted that the day is 
coming when a serum, or antitoxin of tuberculosis, will be found 



GEXERAL DISEASES. 377 

that will prevent and cure the disease, and consumption be 
stamped out, as small-pox has been wherever vaccination has 
been practiced. Various serums are now made and used with 
more or less success, but the subject is yet in the experimental 
stage. 

General Preventive Measures. — As has been said, in prac- 
tically all cases of consumption of the lungs the germs of the dis- 
ease enter the lungs from the air. How do they get into the air? 
In this way : A person affected with consumption spits, anywhere 
and everywhere, a sputum swarming with germs. It dries and 
the germs float about in the air as dust. Drying does not kill them, 
and when they are taken into the lungs they are ready to begin 
their destructive work. Until the germs have become dry they 
do not rise in the air. The main point then in preventing the 
spread of the disease is the disinfection of sputa. For this reason 
the patient should never spit, except in some vessel or receptacle 
that can be disinfected and the germs thus be destroyed. If he 
uses a metallic vessel it should always contain a solution, either 
of carbolic acid — half a teaspoonful to the ounce of water — or of 
corrosive sublimate — corrosive sublimate, two drams; tartaric 
acid, one dram; water, one gallon. The vessel should be washed 
every day. first with boiling water, then with some of the solution. 

Another good plan is to use small pasteboard boxes, or Jap- 
anese rice paper napkins, then burn them. On no account should 
the patient spit on the floor, or about public places, or on the 
floor of a public conveyance, car or boat. When traveling he 
may carry a small flask with metallic screw cap. This can be 
cleaned by boiling, or with the carbolic solution. 

When a room is to be occupied by a consumptive patient, it 
should be stripped of all upholstered furniture, carpets and heavy 
curtains or hangings. Carpets may be replaced by rugs, that can 
be frequently shaken and aired. 

As the sweat of the patient may contain the germs, no one 
should sleep with him. It is also better that he should use sepa- 
rate dishes, knives, forks, etc. He should be very careful not to 
get sputa on his clothes, the bedding, furniture, or floor. A 
tubercular mother should not nurse her baby. The room or 
house occupied by a consumptive patient should always be thor- 
oughly disinfected before being taken by another tenant. 

To do this follow carefully the directions given in the chapter 



378 ; GENERAL DISEASES. 

on disinfection in this work. All the clothing and bedding should 
be boiled for half an hour or more. The body of a person 
having died from any infectious disease should be cremated. 

ACUTE CONSUMPTION. 
(Quick Consumption.) 

Quick consumption is a rapid variety of consumption of the 
lungs. It is comparatively rare. The lungs rapidly soften and 
break up, small abscesses are formed and the whole of both lungs 
is often diseased. This form occurs most frequently in children, 
and often follows measles or whooping cough. 

Symptoms. — In the beginning the disease may resemble 
either bronchitis or pneumonia. The cough is more continuous, 
and soon there is fever with sweats. The child loses flesh very 
rapidly. The cough becomes loose and there is profuse muco-pur- 
ulent expectoration. Hemorrhage from the lungs may occur 
early. There are often periods of temporary improvement. Dur- 
ing the first week the disease may not be differentiated from 
pneumonia, but there is no crisis, as in pneumonia, and the patient, 
instead of getting better, continually grows worse. The disease 
lasts from three weeks to three months; sometimes longer. The 
result is death. It may occur within a few weeks, or months, al- 
ways inside of a year. 

Treatment. — The treatment is the same as for the more 
chronic forms of consumption. 

PLEURISY. 

Pleurisy is an inflammation of the pleura, or serous sac in 
which the lung is enclosed. Most cases of the disease are really 
cases of tuberculosis of the pleura. Many cases are caused by 
exposure and chilling or "taking cold." It is sometimes caused 
by Bright's disease. It usually follows a penetrating wound of 
the chest. There is more or less pleurisy in all cases of pneu- 
monia and pulmonary consumption. The disease occurs in the 
winter or spring months, is more frequent in males and is com- 
paratively rare in children. 

Symptoms. — In order to understand the symptoms it is nec- 
essary to know something of what is taking place within the 
pleura. There is first a congestion and swelling of the mem- 
brane, then the formation of a kind of false membrane on its sur- 



GEXERAL DISEASES. 379 

face, as in diphtheritic sore throat. This false membrane may be- 
come permanent in places, forming bands (or adhesions) between 
two adjacent surfaces. These adhesions obstruct the movements 
of the lungs ever afterward and, at times, produce a sharp pain, 
known as a stitch in the side, or a pleuritic stitch. In many cases 
there is exudation of a thin fluid, or serum, into the pleural sac. 
This is called a pleural effusion. It may be absorbed again, or 
may not, in which case it must be removed by surgical means. 

In some cases pus germs enter the pleura, and the sac then 
soon contains a large quantity of pus. This condition is called 
empyema. It more frequently follows pneumonia. 

The first symptom is usually a sharp pain in the side of the 
chest, but there may be a few days of discomfort preceding this, 
and there may be a chill. The pain is cutting or lancinating, and 
it is aggravated by breathing. To avoid pain as much as he can, 
the patient breathes quickly and with as little movement as pos- 
sible. There is a hacking cough. 

This increases the pain so, it is made very short. There is 
little or no expectoration. There is always fever, but it is not as 
high as in pneumonia; usually running from 102 to 103 in the 
beginning and falling gradually. The patient lies on the affected 
side, in order to lessen its movements and so lessen the pain. 
Some cases begin with no noticeable symptoms and the patient, 
.with a large pleural effusion, may go about, apparently well. Some 
persons may even go through the whole course of pleurisy, from 
beginning to recovery, and never know it. It is a difficult disease 
to recognize, except by a careful examination of the lungs. 

Prognosis. — Cases caused by a cold always recover. Tuber- 
cular cases often recover, too, if properly treated. The disease 
usually lasts from one to two weeks, but may go on for months. 
Pleurisy in the course of Bright's disease and pulmonary consump- 
tion is always fatal. 

Treatment. — Alany simple cases recover without treatment. 
Bleeding was formerly resorted to and did much good, but, owing 
to a changed sentiment, it could hardly be used now. A blister 
over the seat of pain is one of the very best measures. After the 
blister, the silk or cotton-batting jacket should be worn con- 
tinuously. Morphine (one-fourth grain) is often necessary to re- 
lieve the pain. It is essential that the bowels be kept moving 
freely. A physician must be called sooner or later, as there are 



380 GENERAL DISEASES. 

features of the disease that cannot be recognized by the average 
person, much less treated by him. When there is a pleural effu- 
sion, the physician gives remedies designed to aid in its absorp- 
tion. If it is not absorbed it must be withdrawn by tapping, or 
by incision, through the chest wall. Either is a simple operation, 
attended by little or no danger. If the sac is infected and becomes 
filled with pus, we have the condition known as empyema. 

EMPYEMA. 

This is a condition in which there is suppuration in the pleural 
membrane and pus in the pleural sac. It is most frequent in chil- 
dren, and the majority of cases occur with or follow some form 
of pneumonia, but it may follow pleurisy and, more rarely, measles 
or scarlet fever. It also follows penetrating wounds of the chest. 

Symptoms. — The onset varies so greatly as to render descrip- 
tion useless, but after there is pus in the pleural cavity the symp- 
toms are quite uniform. The child is pallid, bloodless, weak and 
emaciated. The breathing is always rapid (from forty to seventy) 
and difficult. There is cough and an extremely variable fever, 
and sometimes there are chills, fever and sweats, as in malarial 
fevers. When the disease goes on several weeks it may be easily 
mistaken for consumption. There is clubbing of the fingers, loss 
of appetite, cough, emaciation and even swelling of the feet. The 
physician makes sure of the presence of pus in the chest by use 
of the hypodermic syringe. 

Prognosis. — In children, under one year of age, fifty per 
cent die. In older children and adults, if the disease be seen rea- 
sonably early (within one or two months), and properly treated, 
recovery is the rule. It is the cases that have gone untreated a 
long time, or refuse an operation, that end in death. There is 
scarcely another disease that brings a child so low, yet is treated 
with so much satisfaction and success. 

Treatment. — There is no choice or variety of methods in 
the treatment of empyema, for there is but one thing to do. Call 
a surgeon who will remove the pus at once by an operation ; that 
is, by an incision through the chest wall. When this is done prop- 
erly, there is little danger, and recovery is the rule. ' When it is 
not done, death is almost certain. 



CHAPTER VII. 
DISEASES OF THE NOSE AND THROAT. 

By W. E. McVey, M.D. 

CAUSES OF COLDS. 

To know how to prevent colds we should know something 
of their causes. They are usually supposed to be due to sudden 
changes of temperature, drafts of air or exposure; but in perfectly 
healthy persons these things alone will not cause colds, for they 
make no impression upon one who has a normal digestion, a 
normal circulation and a properly attuned nervous system. The 
digestive organs, the circulatory system and the nervous system 
are so intimately related that a disturbance of either is sure to 
affect the others. 

The natural consequences of a bad digestion are impaired 
nutrition, blood but poorly supplied with nourishment for the 
support of the tissues, and a resulting loss of energy in the nervous 
system, whereby it can but imperfectly bring about the changes 
in the circulation which are necessary to the elimination of poisons 
and to the protection of the body against the irritant effects of 
heat, cold and dampness. The same results may arise from any 
impairment of the nervous system or of the circulatory system 
itself. 

In a condition of perfect health the circulation readily reacts 
upon the depressing influences of atmospheric changes, so that no 
harm is done, but if either of these great systems is in a bad condi- 
tion the defense is broken and the influence of the irritant is felt 
first in that part which can make least resistance. The weakest 
part of the body is the respiratory tract (organs of breathing), and 
usually the weakest part of that is the nose ; hence, the most fre- 
quent result of exposure is a cold in the head. The resistance 
having once been overcome, each succeeding attack becomes 
more and more serious, until a condition of continuous cold is 
established. 

3 8i 



382 GENERAL DISEASES. 

THE PREVENTION OF COLDS. 

The most important thing, then, in the prevention of a cold, 
is the maintenance of a perfectly healthy body, and this can be 
done only by a careful observance of the rules of exercise, diet 
and hygiene. There are many people, although apparently 
healthy, in whom there is but little vigor. They lack the power 
of resistance and consequently are among the most frequent suf- 
ferers from colds. In the preventive treatment of such cases two 
plans have been suggested : 

First. Protect the body with heavy clothing and wraps from 
all possibility of exposure. 

Second. Stimulate reaction and accustom the body to sudden 
changes of temperature by exercise and training, thus increasing 
its vitality. 

A large majority of the class mentioned adopt the first plan, 
and, in consequence, suffer from every accidental exposure. The 
man who never wraps his neck seldom has a cold or sore throat, 
because his neck, like his hands and face, have become accus- 
tomed to changes. Those in the habit of "wrapping up" will most 
certainly take cold if caught without the usual amount of protec- 
tion, and it is to such people that the second plan of prevention 
should be rigorously applied. They should begin in summer to 
prepare for winter, by taking, every morning, a cold bath, or at 
least a cold shoulder and chest bath, followed by vigorous rubbing 
with a rough towel. This should be continued persistently sum- 
mer and winter. If begun in summer the gradual change in the 
temperature of the water will hardly be felt and reaction from the 
cold bath will be immediate. 

In cold weather one should wear only such wraps as are 
needed for comfort, and should under no circumstances bundle 
the neck and ears. Outdoor wraps should be removed on entering 
warm rooms. The feet should be kept dry. Heavy overshoes, fur 
caps and fur overcoats should be reserved for long drives or visits 
to very cold regions. People subject to frequent colds in the head 
or frequent attacks" of sore throat or bronchitis will find this course 
of great benefit. 

A cold may manifest itself within a few hours after exposure, 
or it may not appear for a day or two. The usual symptoms at 
first are malaise, aching of limbs and back, fever, some headache, 
thirst and a dryness of the nose or throat, or both, and a sensation 



GENERAL DISEASES. 383 

of fullness in the nose. Later the dryness disappears and there is 
a profuse watery discharge, to be followed later by a thick, yellow- 
ish- discharge, which may continue for days or weeks. The fever 
and aching of the first stage usually subside after the free, watery 
discharge has well begun. 

Treatment. — A cold may be aborted if treatment be begun 
early enough. 

The patient should prepare for bed, soak his feet for about 
1 5 minutes in water as hot as can be borne, drink a hot lemonade, 
slip into bed and cover up warmly. In moderate cases this is all 
that is necessary. In more serious cases it is well with the hot 
drinks to give from five to ten grains of Dover's powder, and, if 
the attack seems very severe, a five-grain capsule of quinine. 

If the cold is thoroughly established, give a pill or capsule 
composed of two and a half grains each of salol and phenacetin 
every four hours, and spray or douche the nose every two or three 
hours with hot water containing a teaspoonful of listerine, or a 
pinch of common baking soda, to each half-glass of water. Every 
cold should be thoroughly cured and means adopted to prevent 
further attacks, for frequent colds develop chronic cold or 
catarrh. 

CATARRH OF THE NOSE. 
(Chronic Rhinitis.) 

There are three distinct forms of catarrh : Catarrh of child- 
hood (mnco-piiriilent rhinitis) , dry catarrh (atropine rhinitis) and 
common catarrh (hypertrophic rhinitis.) 

The Catarrh of Childhood, sometimes called snuffles, is the 
form most frequently found in children, especially in those much 
exposed and poorly fed, or who have inherited scrofulous tenden- 
cies. Glandular tissue is more liable to inflammation or disease 
in children than in adults, and it becomes diseased more readily 
than the other tissues. In children who have frequent colds the 
'tissues in the nose that secrete mucus become inflamed, and, if 
the child is badly nourished, either from exposure and bad food, or 
from inherited tendencies to disease, the inflammation is likely to 
become chronic. There is, then, an excessive discharge from the 
nose which changes in character as the disease advances, being at 
first watery mucus, then somewhat thicker and mixed with pus, 
which makes it yellowish in color. There is usually considerable 
swelling of the membrane of the nose, so that the child often 



384 GENERAL DISEASES. 

breathes with the mouth open. The accumulated discharge in the 
nose makes a disagreeable rattling sound as the air passes 
through it and the child frequently draws the discharge back into 
the throat and swallows it. If the nose is nearly closed by the 
swollen membranes the discharge runs out the front of the nose, 
and, from its irritating effect, the edges of the nose and upper lip 
often become sore and, frequently, covered with scabs. 

This condition may go on for years, sometimes better and 
sometimes worse, until the secreting tissue has been mostly de- 
stroyed and the inflammation has extended to other tissues. 

Treatment. — The treatment should be both local and consti- 
tutional. By means of an atomizer, or small hand syringe, the 
nose should be thoroughly washed out with a solution of one part 
of listerine to seven parts of warm water. This should be re- 
peated two or three times a day, if the conditions warrant it, until 
all signs of the trouble have disappeared. This is usually all the 
local treatment that is necessary. If there are sores and scabs 
around the nose and mouth they should be carefully washed with 
warm water, then well anointed with carbolized vaseline. The 
badly nourished or scrofulous child should be given tonics. Syrup 
of iodide of iron, in from ten to thirty drop doses, well diluted, will 
be found very efficient. 

Catarrh in Adults. — The other two forms of catarrh occur in 
adult life. 

Before describing them something should be said of the 
structure and functions of the nose. There are three oblong 
masses projecting from the outer wall of each nostril, known as 
the turbinate bodies. The lower, which is the larger one, may 
easily be seen by spreading the nose open a little. 

Each of these bodies consists of a shell of bone covered with 
mucous membrane, in which is a dense network of very small 
blood-vessels. Between these vessels and the nerves and glands 
is a substance termed connective tissue; also some fibrous tissue 
to give firmness to the membrane. The network of blood-vessels 
serves to warm the air as it enters the nose; also to moisten it. 
The air we breathe contains some moisture, but is usually ready to 
take up more, as illustrated by the disappearance of water from a 
dish on a warm day. The air passages below the nose are supplied 
with glands to secrete only sufficient mucus to keep the mem- 
branes soft and pliable. The mouth is kept moist with saliva, and 



GENERAL DISEASES. 385 

the food is moistened by it. but it is not largely secreted except 
during mastication. The month soon becomes very dry at night 
if one breathes with it open. The amount of mucus secreted in 
the bronchial tubes and lungs is very small, and the air, unless satu- 
rated with moisture before reaching the lungs, would soon take up 
all the water from this mucus and leave the membrane dry and 
irritated. The average amount of moisture required to saturate 
the air breathed by a person every twenty-four hours is estimated 
at about a pint, all of which is furnished by the blood-vessels in the 
nose, being exuded through their walls from the blood ; but as it 
is all the time being taken up by the air on its way to the lungs we 
do not notice it. 

As the amount of moisture in the air varies, so the amount 
required from the nose varies, the supply being governed by the 
nerves which control the blood-vessels. If more is required the 
vessels, by dilating, allow more blood to flow, from which more 
can be drawn. Upon the disturbance of this function of the nose 
catarrh and its results chiefly depend. 

This disease is usually a later development of the condition 
existing in children as muco-purulent rhinitis, already described. 
It is in nearly every case confined to adults. The nose is dry and 
the air passages large. Scabs frequently accumulate in the nose 
and often a scab is blown out, having the shape of the nasal cavity. 
If the scabs are retained long they begin to decompose and there 
is a musty odor. The sense of smell is usually lost. When the 
scabs have been forcibly removed there is a tendency to bleed. 
The inflammation which preceded this condition partially or 
wholly destroyed the secreting cells (the epithelium), the deeper 
structures of the membrane have become involved, and, mixed 
with the small amount of mucus now secreted, we have a sticky, 
tenacious material which coagulates, adheres to and contracts 
upon the membrane, forming scabs over a part or all of the inside 
of the nose. 

This condition not only prevents the air from absorbing mois- 
ture from the blood-vessels, but by contraction drives the blood 
out of them, thus depriving the tissues of their nourishment, so 
that they gradually shrink away. From the loss of the moistening 
function of the nose the throat becomes dry and irritable, and the 
patient has a chronic sore throat, and, later, may develop a chronic 
bronchitis. 

25 



386 GENERAL DISEASES. 

Dry catarrh is usually considered incurable, but by persistent 
attention much relief may be afforded, and, if the condition has 
not existed too long, a cure is possible. 

Treatment. — The main object in the treatment is to prevent 
the adherence and formation of scabs. The nose should be thor- 
oughly cleaned with warm water containing five grains of soda 
and two drops of carbolic acid to each ounce, or a teaspoonful of 
listerine to the ounce, after which it should be well oiled with 
melted vaseline, or with the following ointment : 

Vaseline one ounce. 

Boric acid one-half dram. 

Aristol six grains. 

Oil eucalyptus five drops. 

Menthol one grain. 

This is best used in a DeVillis atomizer. Some of the oint- 
ment should be placed in the bowl, then held over a lamp until 
thoroughly melted, when it may be sprayed into the nostril. In 
the melted state it readily spreads over the membrane, and as it 
cools adheres to it, thus preventing the attachment of scabs and 
facilitating the removal of secretions. There will be no odor about 
the nose if it be kept free from secretions, especially crusts and 
scabs. 

After this treatment has been kept up for some time an 
attempt may be made to restore the function of the nose by the 
occasional use of stimulating applications, such as 

Oil of cubebs five to ten drops. 

Alboline one ounce. 

Apply as a spray once a day or every other day. This should 
not take the place of the other remedies, but be used in connec- 
tion with them. 

COMMON CATARRH. 

This form is considered a disease of adult life, although it is 
frequently found in youth. It is a very common ailment, and much 
more common in some regions than in others. It often exists for 
considerable time before demanding attention, when it is noticed 
that there is a varying but constant discharge from the nose, which 
is much increased on going out into the^old air, and sometimes 
greatly aggravated by dust and irritating vapors. There is always 
some closure of one or both nostrils from the enlarged or swollen 



GENERAL DISEASES. 38? 

turbinate bodies. In many cases first one side, then the other, be- 
comes closed, and often one nostril is completely closed so that 
the discharge cannot be blown out, and no air can be inhaled 
through that side. 

When this stoppage is very persistent there is always danger 
of the ears becoming affected, and deafness of one or both ears 
may result. Soon or late the throat is sure to become dry and 
inflamed, because the diseased condition of the nose prevents the 
air from securing the amount of moisture required, and the watery 
part of the mucus in the throat is absorbed; or if the nose be 
stopped the breath is drawn through the throat and the same dry 
condition of the throat follows. 

Among the causes of this form of catarrh are repeated attacks 
of cold in the head, and exposure to dust, especially in a dry climate 
with much wind, but probably the most frequent cause is deformi- 
ties of the nose. In a great many people the septum (partition) 
between the two sides of the nose is bent so that one cavity is 
smaller than the other, and in some cases this passage on one side 
is so small that no air can pass in, while the other side is nearly 
as large as both should be, and all the air passes in at that side. 
It is nearly always found, however, that this large passage is 
partially filled up by a large, red-looking tumor, which is the en- 
larged turbinate mentioned in the first part of this chapter. This 
occurs whether one has had frequent colds or not, and does not 
depend upon dust or climate. 

As has been explained, the network of blood-vessels is called 
upon for more moisture when the air is very dry, and the vessels 
then dilate and more blood enters. If this demand is permanent 
the vessels remain enlarged — constantly engorged with blood. 
The water escapes from the vessels and the membrane becomes 
swollen. From the increased supply of blood there is overnutri- 
tion of the part and new tissue forms, so that the turbinate bodies 
are not only swollen, but thickened (hypertrophied). 

The same conditions are brought about by a deformed sep- 
tum, and in the same way, for one side of the nose, being often 
much larger than the other, admits more than its share of the 
breath, to saturate which it must furnish more than its share of 
water, and the effect upon the vessels is the same as that of a dry 
atmosphere. These deformities are almost always the result of 
injuries, and usuallv of those received in childhood, as from falls 



388 GENERAL DISEASES. 

or blows upon the nose. The injury itself may not have been 
serious, but results in a slowly developing deformity. 

Treatment. — Persistent treatment will, in the majority of 
cases, cure this form of catarrh. The first essential is cleansing the 
nose. This may be accomplished in the same way and by the same 
means as suggested for dry catarrh. After a thorough cleansing, 
each side of the nose should be sprayed by an atomizer with some 
of the following : 

Alboline two ounces. 

Menthol twenty grains. 

Oil eucalyptus five drops. 

Oil cinnamon five drops. 

Repeat this every day well and persistently for months if 
necessary. 

It is also well to use occasionally an astringent powder. The 
following may be snuffed into the nose every day or two : 

Salicylic acid ten grains. 

Tannic acid one dram. 

Subnitrate of bismuth one dram. 

If the obstruction of the nose is very great, or if there is very 
much thickening of the tissues, these milder measures will do little 
more than give temporary relief. In these conditions the extra 
tissue must first be removed or contracted by a surgical operation, 
which is simple and almost painless, after which the nose should 
be treated as above prescribed. No catarrh snuff or other remedy 
should be used which contains cocaine, as by the' continued use 
of these so-called catarrh cures many have acquired the cocaine 
habit. In mild cases a simple, douche of hot water, containing a 
little soda, will often give great relief, and sometimes afford a com- 
plete cure. The most careful observance of the hygienic rules sug- 
gested early in this chapter must be insisted upon, if any perma- 
nent benefit is to be derived. 

ADENOID GROWTHS. 

Adenoid (gland-like) growths are masses of soft, spongy tis- 
sue which form in what is called the naso-pharynx- — that part of 
the throat which lies behind the nose and soft palate, reaching 
nearly to the lower level of the latter. They form upon the wall 



GENERAL DISEASES. 389 

of this space, hanging down in such a way as to sometimes block 
up the openings from the nose into the throat, and are of consider- 
able importance because of their interference with natural breath- 
ing, compelling the child to breathe through its mouth and pro- 
ducing a peculiar facial expression. There is a dull, heavy look 
about the eyes, with a prominence of the upper jaw, causing, in 
many cases, an almost idiotic expression ; and there is usually con- 
siderable discharge which is frequently removed by disagreeable 
hawking. If the condition be not relieved permanent damage to 
the ears may result. They are principally found in children and 
disappear after adult life is reached. 

Treatment. — Removal of the growths is the only satisfactory 
treatment. This is not a difficult or very painful operation, and 
is usually done by crushing the soft masses with the fingers, or by 
an instrument devised for the purpose. After the growths have 
been removed by the surgeon the nose and throat may be treated 
after the same plan suggested for chronic catarrh. 

If the child is poorly nourished and has a fickle appetite, he 
should be given the syrup of the iodide of iron in doses of from 
twenty to thirty drops after meals. 

DISEASES OE THE PHARYNX. 

The Pharynx, or upper part of the throat, is that cavity the 
largest part of which may be seen through the arch at the back of 
the open mouth. The gullet and larynx open into it from below, 
the mouth and nostrils from above ; it also communicates with the 
drums of the ears by means of two narrow channels called the 
Eustachian tubes. 

The Palate is the roof of the mouth. Its front and back por- 
tions are known respectively as the hard and soft palate ; the hard 
palate being the bony portion bounded in front by the sockets of 
the teeth in the upper jaw ; the soft palate consists of the movable 
muscular portion or back part of the roof. 

The Uvula is the little pendant which hangs from the center 
of the- back edge of the soft palate. 

The Fauces is the name given to the back part of the mouth 
or the passage from the mouth cavity to the pharynx, overhung 
by the soft palate and bounded on its sides by the pillars of the 
soft palate, sometimes called the pillars of the fauces. 

The Tonsils are the two prominent oval bodies situated one 



390 GENERAL DISEASES. 

on either side of the throat near the back part of the tongue, and 
at the summit of the pharynx. The purpose of these glands has 
never been discovered; a person is quite as well off without them, 
and in many people they seem to exist only to become diseased. 

The tonsils, as we usually find them, are enlarged glands, or 
masses of glands, situated one on either side of the throat near 
the back part of the tongue. When much enlarged they are very 
easily seen, looking like large red tumors, which sometimes seem 
to come together behind the tongue. Often several large holes 
may be seen in each tonsil. 

Sometimes these holes are filled with a mattery-looking fluid, 
or may contain masses of cheesy-looking material. If much 
enlarged, the tonsils interfere with breathing through the nose, 
especially on lying down, by filling up the space between the back 
part of the nose and mouth. The same effect upon the counte- 
nance and ears may be expected in this condition as in the adenoid 
growths. In children they often hinder development and cause 
ill health, both because of their interference with normal breath- 
ing and quiet sleep, and by their absorption of poisons. They are 
most common to childhood, although not infrequent in adult life ; 
but in adults, because of the mouth and throat being larger, they 
do not so much interfere with breathing. They should be removed 
by the surgeon. The operation is almost painless, and it is the 
quickest, safest and in all respects the best treatment. 

TONSILITIS. QUINSY. SORE THROAT. 

This is an acute inflammation of the tonsils, and usually oc- 
curs in persons who have enlarged tonsils, and particularly in those 
who have a rheumatic tendency. By many physicians, acute ton- 
silitis is considered one manifestation of rheumatism. It usually 
comes on with a feeling of malaise, aching of the limbs, chill or 
chilly sensation, headache, fever, dryness of the throat, and pain, 
especially about the angle of the jaw. 

Swallowing becomes painful and difficult, so that often noth- 
ing but liquids can be swallowed, and they are liable to come back 
through the nose. The swelling of the tonsils may become so 
great that the patient is threatened with suffocation, although this 
seldom if ever occurs. Usually at the latter end of the attack, 
which may last from four or five days to two weeks, if the swell- 
ing has been very great, the tonsil begins to look red and tense 



GEXERAL DISEASES. 391 

at some point, and soon breaks, discharging considerable matter 
and blood, after which recovery is quite rapid. It is frequently 
advisable to hasten this process by lancing. 

One or both sides may be affected at the same time, or, very 
often, the attack is prolonged by one side becoming affected about 
the time the other side is getting well. The fever accompanying 
an attack of tonsilitis may be quite high, and the patient is usually 
weak and much exhausted during convalescence. Although a 
great many things have been considered causes of this disease, it 
can most frequently be ascribed to enlarged tonsils, or to a rheu- 
matic tendency, or, more frequently, to both these conditions 
joined to exposure. 

Treatment. — When the attack first comes give a cathartic, 
such as a teaspoonful of sulphate of soda every four hours until 
the bowels move freely. Then, to control the fever and check the 
disease, a pill or capsule containing two and a half grains each of 
phenacetin and salol should be given every four hours. When 
the throat first begins to feel sore a counter-irritant, such as a 
mustard plaster, applied to the neck, care being used not to pro- 
duce a blister, will often be of benefit. The throat should be fre- 
quently gargled with hot water containing some antiseptic, such 
as one part of listerine to seven parts of the water. The throat 
usually feels hot and dry. and a spray of menthol and oil (see page 
386 for formula; will be very grateful to the patient. 

Dry heat may be applied to the neck, but poultices should not 
be used. A moist poultice moistens the skin, but, since the tonsil 
usually breaks upon the inside, this does not assist the process 
more than dry hot applications, and the latter are more pleasant to 
the patient. After the tonsil breaks the throat should be fre- 
quently washed out with listerine and hot Avater, until the dis- 
charge ceases. 

FOLLICULAR TONSILITIS. 

This is a much severer form of inflammation of the tonsils, and 
is due to a specific poison. All of the symptoms are more marked 
and more severe. The tonsils appear to be covered with white 
or grayish spots, from the fact that it usually begins in the crypts. 
or openings in the glands, and in the follicles which open into these 
crypts. These spots usually get larger until several may come 
together, forming a large gray mass or slough, which finally comes 
away, leaving a lar°:e hole behind. 



392 " GENERAL DISEASES. 

The whole gland may be destroyed in this way. It resembles 
diphtheria very closely and is so difficult to distinguish from it 
that physicians usually place cases of this kind under the same 
restrictions as diphtheria. 

See Fig. 2, Plate VI. 

Treatment. — In uncomplicated cases the use of the cathartic, 
the phenacetin and salol, and the listerine gargle, as just prescribed 
for quinsy, will often prove very efficient. In addition to these 
the throat should be brushed or swabbed twice a day with gly- 
cerole of tannin. Since, in its graver forms, this is a serious dis- 
ease, its treatment should be under the direction of a skillful phy- 
sician. 

PHARYNGITIS. SORE THROAT. 

Pharyngitis may be either acute or chronic, but the chronic 
form, with frequent acute attacks, is the more common. An 
acute simple pharyngitis usually arises from taking cold. There 
is a sense of dryness and stiffness of the throat, with considerable 
heat and some pain on swallowing or attempting to talk. The 
throat looks red and glazed, or, later, may be covered with a 
thick white or grayish secretion, which, after a few days, disap- 
pears. 

Debility from any cause, sedentary habits, and rheumatic or 
scrofulous tendencies, by lessening resistance, may be predispos- 
ing causes. 

Simple gargles of hot water with a little soda, or a spray of 
menthol and almond oil, are usually sufficient for local treatment. 
A light physic and three grains of quinine every four hours will 
usually bring about a recovery. Acute pharyngitis may be modi- 
fied by conditions previously existing in the throat, the attack 
being simply an increase of a chronic trouble. 

Chronic Pharyngitis is usually a result of nasal catarrh with 
obstruction and loss of function in the nose, or of exposure of 
the throat to irritating dust or vapors for long periods, or it may 
be a result of over or injudicious use of the voice, as w T ith preach- 
ers or outdoor speakers. The throat looks rough and usually 
there are little red elevations seen in the back of it, which are very 
sensitive when touched. The throat at times, especially in the 
night, becomes dry and stiff, and in the morning is likely to be 
found coated with a dry, stiff secretion, which it requires repeated 
hawking to remove. The voice is generally changed in character, 



w 




<* 







S 

i 



GENERAL DISEASES. 393 

and speaking is difficult and painful. The pharynx is very subject 
to irritations and is likely to be much affected by digestive dis- 
turbances. Slight exposures in damp or variable atmospheres 
exaggerate the symptoms and often bring on acute attacks. A 
cough often accompanies the disorder, and in many cases the 
vocal organs and bronchial tubes become affected. 

Treatment. — Pharyngitis is a serious condition and requires 
long and systematic treatment for permanent relief. If it is de- 
pendent upon nasal catarrh that condition should be removed. 
The secretion that collects upon the mucous membrane of the 
throat should be carefully removed in such a way as to cause the 
least possible irritation. This may be done with dilute listerine, or 
warm water in which enough soda has been dissolved to give 
it a slightly alkaline taste. The throat should then be well 
sprayed with the oil and menthol solution recommended for 
common catarrh. Two or three times a week the red points 
should be touched with tincture of iodine after the washing 
process, and should then be immediately sprayed with the oil 
mixture. 

The worst form of chronic pharyngitis is the dry or atrophic 
form. This usually follows a catarrh of the nose, when the func- 
tion of the nose has been almost entirely destroyed. The throat 
looks dry and glazed, and there are streaks of thick, tough secre- 
tion which, when removed, leave the throat very red and in- 
flamed. It is continuously sore and stiff, and often causes much 
pain in swallowing or speaking. Great care should be used in 
cleaning the throat, as the removal of the tough mucus irritates 
the membrane. It is best in such a case. to spray thoroughly with 
the oil solution in the morning before attempting to remove the 
collected mucus. The oil saturates it and protects the mem- 
brane, and should be used as a spray several times each day, and 
once each day the throat should be sprayed with the following: 
Oil of cubebs four drains; albolene four ounces. The treat- 
ment must be regularly continued for several months if any perma- 
nent benefit is to be gained. 

THE VOICE. 
The Larynx is the voice-box at the top of the windpipe or 
trachea, containing the vocal cords or lips of the glottis. It is 
situated in the throat, just below the angle of the throat and 



394 GENERAL DISEASES. 

lower jaw, and is composed of two principal cartilages, the thy- 
roid and the crycoid. Roughly speaking, this voice-box is a 
short tube, three-cornered above and cylindrical below, and, 
being larger at the top than at the bottom, may be said to 
resemble a funnel, the upper part of which has been bent into 
a triangular shape. 

The Epiglottis or lid is a soft elastic substance which closes 
the upper opening of the larynx during the act of swallowing 
and thus protects the larynx with its delicate organs while the 
food and drink pass over it into the gullet or esophagus on their 
way to the stomach; it is sometimes called the cover cartilage. 

The Vocal Cords or vocal ligaments are two ledges of elastic 
tissue, covered with very delicate membrane. Each of them 
is connected on one side along its whole length with the shield 
cartilage of the larynx, and their ends also are joined to other 
parts of the larynx. The term is misleading, as it implies strings 
like those of the violin or other musical instruments, attached 
only at the ends and left free at every other point, which is not 
true of the vocal cords, for they are each attached along one 
side as well as at both ends and are free only along their inner 
edges, and resemble membranes or bands rather than cords. 

All rules for the care and development of the voice must 
be in accord with the physiological action of the organs involved 
in its production. The larynx is primarily the vocal organ and 
much of the character of the voice depends upon the peculiari- 
ties of its construction, but there are other organs and functions 
concerned that are of great importance. The primary sound is 
produced by the vibration of the vocal cords, and these are set 
in vibration by the column of air expelled against them by the 
lungs, the cords being put upon a stretch and brought closely 
together. The pitch of the sound will depend upon the length 
of the vocal cords, the shorter the cords the higher the pitch 
of the sound produced, and upon the degree of tension, the pitch 
being proportional to the square root of the tension. 

The intensity depends upon the strength of the air blast ; 
the more vigorous the expiration the greater the intensity of 
the sound. The expired air is, therefore, the power which pro- 
duces the sound, and is absolutely necessary to the production 
of voice sounds of any kind. 

Upon the perfection and capacity of the breathing apparatus 



GEXERAL DISEASES. 895 

depend the strength and duration of the voice both in speaking 
and singing. Xo matter how complete the construction of the 
larynx, if there be deficient lung capacity the voice will lack 
the very essential features of force and duration. It will also 
lack volume, and it is from this want that so much trouble is 
frequently produced in the throat by singing or outdoor speak- 
ing, for the person tries, by contracting the muscles of the throat 
and narrowing the tube through which the sound waves pass, 
to make up by intensity what is lacking in volume. Long or 
oft-repeated sentences of this kind result in congestion of the 
pharynx, an enlargement of the secreting follicles and a perma- 
nently altered voice. 

We have spoken of lung capacity, but there is another ele- 
ment which must be considered, and that is the correct method 
of breathing. Proper breathing is that by which the whole 
lung expands at each inspiration. Any mode of dress which 
prevents the expansion of the lower parts of the lungs, or any 
habit which restricts the movements of respiration to the upper 
parts of the chest, is injurious to the proper development of the 
voice, and to such dress and habits are due much of the throat 
trouble which afflicts singers and speakers. In this type of 
breathing the abdominal wall is drawn in while the chest is 
expanded. The proper method of breathing is neither abdominal 
nor costal alone, but a combination of the two. At the same 
time that the ribs of the chest are pushed outward and upward, 
the diaphragm is pushed downward and the abdominal wall 
becomes more prominent, so that the whole of the chest cavity 
is increased in size, allowing the greatest freedom for the expan- 
sion of the lungs. 

THE CONTROL OF THE BREATH IN SINGING AND PUBLIC 

SPEAKING. 

With ample lung capacity and a correct method of breath- 
ing, there is still another consideration to be taken into account. 
It is necessary, the chest having been filled with air, to be able 
to perfectly control its escape so that the various degrees of 
tone power, from the softest possible sound to the most glorious 
outburst, may be furnished. The escape of air must be con- 
trolled in such a manner that there shall be perfect freedom of the 
muscles about the throat. A great many control the expulsion 



396 - GENERAL DISEASES. 

of air by contraction of the muscles of the larynx, but it is evi- 
dent that this prevents a free action of the vocal cords, and, 
in the effort to sing, or in public speaking, results in considerable 
strain and often in injury to these delicate organs. 

In ordinary breathing the expiration of air is a passive move- 
ment, but in singing, when the lungs are filled with air, it is 
necessary to be able to govern its expiration by the muscles 
of the chest and diaphragm so that the air is retained or expelled 
at will. This is not a difficult thing to learn, as will be found 
by a little practice. A voice which is throaty or tremulous can 
usually be corrected by applying the principles suggested. As 
a preliminary to the study of vocal music, every student should 
be required to take a course in chest development and breathing 
exercises. 

DISEASES OF THE LARYNX. 

Diseases of the larynx are dangerous to life because the 
narrow space between the vocal cords, through which air is 
admitted to the trachea, and through the treachea and the bron- 
chial tubes to the lungs, may become very much narrowed or 
entirely closed as a result of such diseases, and because the 
epiglottis, which is frequently involved in an acute inflammation, 
may become so swollen as to entirely cover the opening and 
prevent the entrance of air. They are frequently very serious, 
also, because of the permanent alterations which they may pro- 
duce in the voice. For these reasons, although there are many 
diseases of the larynx, for all but the simpler ones a physician 
or specialist should be consulted as early as possible. 

In many cases of irritable pharyngitis, where there is much 
cough, the larynx may become sore and inflamed from constant 
coughing. It usually passes off on removal of the cause. A 
simple laryngitis is usually a result of a cold. Many people on 
taking cold feel the first effect in a soreness of the larynx, with 
hoarseness and cough. The trouble may remain in the larynx, 
but usually it progresses into the trachea, and sometimes into 
the bronchial tubes, before relief is obtained. The ordinary treat- 
ment for a cold, as already outlined herein, is the proper plan to 
pursue, with the addition of steam inhalation. A paper cone 
placed over a cup of steaming hot water, into which a little 
camphor or oil of pine has been dissolved, makes a very con- 



GEXERAL DISEASES. 897 



venient inhaler for this purpose, the apex of the cone being 
taken in the mouth. While inhaling the steam the breathing 
should be natural or but slightly increased in depth. The inhala- 
tion may be repeated every hour or two and affords much com- 
fort as well as hastens the cure. A spray of peppermint and oil 
may be thrown downward in the throat during inspiration, or 
with an ordinary atomizer the larynx may be thoroughly medi- 
cated by closing the lips over the tube and breathing deeply 
while the spray is made. 

Counter-irritants applied to the outside of the neck may 
prove of much service at the beginning of the attack. [Mustard 
plasters, or an application of kerosene, will answer the purpose. 
It is not desirable to keep the neck bundled in flannel cloths, as 
is often the custom. The bowels should be kept freely open, 
and if there is much cough it should be controlled with small 
doses of Dover's powder, or some opiate mixture, for these, 
while relieving the cough, also prevent spasms of the glottis, 
which are painful and occasionally threaten life. 

A very good cough mixture for such cases is made as follows : 

Paregoric two parts. 

Rum one part. 

Treacle one part. 

Dose. — A teaspoonful every three or four hours, as may be 
indicated. 

-V very grave complication may arise in apparently very mild 
cases. The tissues about the larynx, especially the membranes 
covering the epiglottis, are liable to become infiltrated with serum, 
and they may rapidly become so puffed that suffocation is threat- 
ened. In such cases, if medical assistance be not at hand, the 
patient should be put into a sweat bath as quickly as possible 
and freely given hot drinks and hot steam inhalations. If the 
condition is not readily relieved, it may be necessary for the 
physician to puncture the swollen tissue and allow the fluid to 
escape, or if there seems great danger of immediate suffocation 
it ma}" be even necessary to open the trachea through the neck, 
that air may be admitted to the lungs. 

If an attack of laryngitis be long continued and accompa- 
nied with much cough and hoarseness, the voice may be per- 
manently changed, occasionally completely lost. If the trouble 



398 GENERAL DISEASES. 

does not readily yield to the simple plans of treatment, a physician 
should be consulted, for the condition may be due to tuberculosis, 
or some other infection, or a tumor may be developing in the 
larynx. There are many chronic diseases of the larynx, and as 
their proper management requires skill and experience, we can 
only recommend the most simple measures for the patient's 
own administration. Consumption often begins with a tuber- 
cular laryngitis which, with prompt and proper treatment, may 
be cured and the patient's life prolonged, but very early recog- 
nition and attention are required. If there be a history of tuber- 
cular infection, much relief will be afforded the trouble in the 
larynx by inhalations of pure beechwood creosote, taken by means 
of the simple paper inhaler already described, using five or ten 
drops of the creosote in place of camphor or in connection with 
it. A physician should be consulted as early as possible, how- 
ever, for the progress of the disease may indicate additional 
treatment. 

The importance of giving early attention to any disease 
of the larynx cannot be too srongly urged, on account of the 
delicacy of its make-up, and its relation to the most important 
function of life, respiration. Because of the alteration of voice 
in protracted cases of pharyngitis, people are often led to believe 
that the vocal cords are affected, but it will usually be found 
that there is nothing the matter with the larynx excepting a 
slight irritation, the change in the voice and difficulty in speak- 
ing being due to the thickening of the membrane covering the 
rear wall of the pharynx, which acts as a sounding-board for the 
vocal organs. 

The involvement of the larynx in catarrhal diseases of the 
nose and throat is usually due to irritation from mouth breathing, 
from coughing, or from reflex irritation, and depends for its cure 
upon the relief of the other troubles. Paralysis of spine part of 
the larynx sometimes follows diphtheria, but is generally onjy 
a temporary difficulty. 

The following warning, given by Pattou in his excellent work 
on "Voice Production," cannot be too carefully heeded: "Breath- 
ing cold air through the mouth, besides drying the mucous mem- 
brane of the pharynx and larynx, exposes these parts to unnat- 
ural and sudden reduction of temperature, in consequence of 
which temporary hoarseness is often produced. But particularly 



GENERAL DISEASES. 399 

when the vocal organs have been overexercised and overheated, 
by singing or speaking in warm rooms or halls, should the singer 
or speaker refrain from exposing himself, without due precau- 
tion, to the very cold or damp outdoor air; and surely he should 
not breathe with open mouth unless he desires to be visited with 
serious disorders of the respiratory organs, such as congestion 
of the larynx or lungs." 



CHAPTER VIII. 
THE EYE AND EAR. 

By J. E. Minney, A.M., M.D. 

The eye and ear are organs of special sensation. They do 
not see or hear, but impressions made upon them are conveyed 
by nerves to the brain, which takes notice of them, and the per- 
ceptions by the brain of these impressions are called seeing and 
hearing. These organs also give expression and beauty to the 
face. Nothing so improves the personal appearance as pretty 
eyes and ears. There are too many diseased eyes and ears; too 
many, because a very large proportion of their diseases are pre- 
ventable. The way to do these organs most good is to intelli- 
gently care for them before they become permanently disabled. 

THE EYE. 

More is now required of the eye than at any other time in 
the world's history, and as success or failure is largely dependent 
upon good sight and hearing during the preparation for the 
life-work, and as the disorders grow more serious, often becom- 
ing incurable with the lapse of years, early childhood is the proper 
time to carefully search for their weaknesses and defects. In 
most cases they may be remedied or permanently cured. 

Children do not often try to deceive. When, to see pictures, 
print or other small objects, they hold them very near the eyes, 
the eyes are at fault. When a child complains that he cannot 
see figures or writing on the blackboard at school, as the other 
children can, his eyes should be examined by a competent ocu- 
list, not by a man who has spectacles to sell and "examines all 
eyes free," for a matter of so much importance should be intrusted 
only to the most thoroughly competent, whose disinterested 
advice can be relied upon and will therefore be worth many times 
the small sum it will cost. If glasses will correct the trouble 
he will order them; if the defect be something else, he will point 
it out and apply the proper remedy, unless it be beyond the 
reach of remedies, in which case both parent and child, by know- 

400 



GENERAL DISEASES. 401 

ing the truth in the beginning", can plan the work for life accord- 
ingly and avoid disappointments and heart burnings in later 
years. 

Twitching Eyelids. — An examination should also be made if 
there be twitching: of the evelids, or if the eves become red and 
water}-, especially if the trouble be made worse by school work, 
reading or sewing, or if much use of the eyes brings on headache. 
This headache is more likely to be a browache ; there may, how- 
ever, be pain in the temples and back of the head or in the neck. 
In some persons an unpleasant blurring of lines occurs in looking 
over striped or checkered goods. At other times there are burning 
sensations, often deep-seated, in the eyes, and the eyeballs feel 
sore when pressed. In such cases advice should be sought. 

Bright flashes of light appearing when the eyes are closed, 
and increasing on lying down, are very grave symptoms, mean- 
ing functional or organic disease of the inner coat of the eye 
(retina). Xo time should be lost before seeking advice. The 
sensation of black floating specks in the eyes may be caused by 
a bad stomach, but it is a dangerous sign. \\ hen the eyeball 
is painful and feels full and hard on pressure it is a serious symp- 
tom. The condition is called glaucoma, hard eveball. Treat- 
ment should be sought immediately. 

Lumps formed in the eyelids are enlarged glands (chalazii). 
Although not generally painful they should be removed. They 
are caused by eye strain and disease of the lids. Small boils 
upon the eyelids are called sties (hordeolii) and are painful and 
red. Owing to the loose structure of the eyelids they sometimes 
cause the whole lid to swell and look puffy. They should be 
opened the same as boils on any other part of the body. Some- 
times they can be driven away by applying hot water to the eye- 
lids. The water should first be boiled for fifteen minutes, then, 
as hot as can be borne, be applied for ten or fifteen minutes from 
the nozzle of a fountain syringe, or from cloths wrung from the 
water every half minute. To secure complete asepsis (freedom 
from all germs) it is necessary to also boil the syringe, cloths 
or any other utensils used in connection with the eyes. When 
the eyes have thus been bathed they should be let alone until 
time for the next douching, unless dry and painful, in which 
case anoint them with a little vaseline. 

Conjunctivitis. — When the eyes are red and the lids stick 

26 



402 GENERAL DISEASES. 

together in the morning, the disorder is called conjunctivitis, 
meaning an inflammation of the inside lining of the eyelids. 
It is caused by dust, smoke, particularly tobacco smoke, exposure 
to cold or heat, bright light, bad ventilation, etc. It is common 
in such occupations as milling, scissor grinding and threshing, 
and is frequently caused by partaking too freely of "bottled 
goods." Certain diseases, as measles and scarlet fever, also 
cause conjunctivitis. When this inflammation lasts several weeks 
it becomes chronic and sometimes gives rise to a condi- 
tion known as granulation of the eyelids. The inner lining 
of the eyelids, called the conjunctiva, when everted (turned out) 
looks rough, an appearance caused by minute, raised, red, warty 
points. 

Sometimes the conjunctiva presents a frog spawn appearance. 
Granulation in any form is hard to cure. Its natural tendency 
is to get worse, and many cases of blindness have resulted from 
granulated eyelids. The treatment should begin early and be 
followed persistently until a cure is effected. 

When the lashes turn in against the eyeball and scratch the 
delicate skin they cause sores and sometimes blindness. An 
operation is required which will cause the lashes to turn outward. 
Pulling them out is a temporary expedient and must be done 
for immediate relief, but as the disorder grows worse all the 
time, an operation is the treatment demanded. 

Ulcers. — Little white specks upon the cornea (crown), com- 
monly called the colored part of the eye, are dangerous. They 
are little ulcers, or blisters that will break and result in ulcers. 
Ulcers are eating sores. They may either come upon or spread 
over the sight of the eye, and, if deep, leave scars when they 
heal. When over the sight of the eye, a white scar causes more 
or less blindness ; hence wounds and ulcers of the eyeballs are 
always dangerous. 

Contagion. — It is prudent to consider every eye affection 
contagious, but especially so when the eyelids stick together, or 
the lashes are matted together, or there is a mattery secretion 
from the eyes. Granulated lids are highly contagious. As a 
measure of safety any person having a sore eye should have a 
wash basin and towel for his own exclusive use, and if the eyes 
be mattery should sleep alone. 

A Pterygium (wing) is a growth upon the outside of the 



GEXERAL DISEASES. 403 

eyeball, extending from the inner corner of the eye, and its 
point sometimes reaches over the colored part and covers the 
sight of the eye. It is of a red or whitish color and is more 
or less fan-shaped, with the handle of the fan pointing toward 
the colored part of the eye. It is not a cataract, though often 
so called. Its treatment consists of its removal, which can safely 
be done. 

A Cataract is an opacity (whiteness) of the crystalline lens, 
and as the lens is situated within the eye directly behind the 
pupil, it gives the naturally black spot in the middle of the 
eye a gray or white appearance. Removal is the only treatment. 
This can be safely done only by a skillful physician, and it must 
be ripe before removal. This condition has arrived when the 
patient is barely able to count his fingers when held two feet 
or less from his eyes. The operation consists of the removal 
of the natural lens and the substitution of a glass lens, after the 
eye has healed, the latter being worn over the eye in spectacle 
form. 

HOW TO FIND THE CAUSE OF AN EYE TROUBLE. 

In searching for the cause of an eye trouble the following 
points should be noted: 

i. The length of time the eyes have worked. They should 
be rested at least every hour. 

2. The character of the work, whether fine or coarse, clearly 
or dimly outlined. The finer the work or the poorer the print 
the longer the eyes should rest, and the shorter should be the 
intervals between the rests. 

3. The distance of the work from the eyes. From twelve 
to fourteen inches is the proper distance. 

4. The character of the light. The best artificial light is 
furnished by the argand burner known as "the student's lamp/' 

5. The relation of the light to the eyes. It should come 
from the left side or above, and is best when falling over the left 
shoulder, especially for right-handed people. 

6. The position of the body. It is very important that the 
upright position be maintained. 

If all the above conditions are found favorable, the uneasiness 
of the eyes on doing their work is probably due to an error of 
refraction or accommodation, for the correction of which proper 



404 GENERAL DISEASES. 

glasses are the remedy. Still, the trouble may be caused by 
a slight congestion of the mucous membrane of the eyes, or by 
some exposure, as to wind, dust or tobacco smoke. 

If error of refraction or accommodation be the cause, pain 
in the eyes is likely to follow; also tenderness of the balls when 
pressed in the morning; or there may be some redness of the 
eyes, or branny scales on the margin of the lids, sometimes accom- 
panied by a slight thickening of the lid margins. Slight shooting 
pains in the brow or temple, increasing to headache, and pain 
in the back of the neck, often come on after a time. Nervous- 
ness and irritability of temper may also attend or follow these 
errors. 

It may be better, before having the eyes fitted with glasses, 
especially if the troubles mentioned have begun, to rest the 
eyes a few weeks and give them treatment. If the difficulty 
be acute conjunctivitis or slight granulation, drop into each 
affected eye three or four dropperfuls (a small syringe such as 
is used to fill a fountain pen is a "dropper") of saturated solution of 
boric acid crystals at bedtime and follow with a little vaseline 
or, if the acid solution be harsh or painful, with cocainized vase- 
line (cocaine one-half grain, vaseline one ounce). 

The hot water treatment recommended for sties is also 
excellent for conjunctivitis when there are free secretions. For 
the congested stage, with dry, hot, shiny mucous membranes, ice 
compresses are probably better. 

When there are branlike scales on the margins of the lids 
and roots of the eyelashes, and crusts form and the lashes fall 
out, either nitrate of silver or the yellow oxide of mercury 
is needed to make a quick cure. The nitrate of silver is used 
as a solution, from five to twenty grains of it to an ounce of dis- 
tilled water. The mercury is used as an ointment, one grain of it 
to one dram of vaseline. Before using either the scales and 
crusts must be completely removed by soaking and washing 
with warm alkaline water, then gently scraping them away, after 
which dry the parts and apply the remedy. In using the oint- 
ment rub it in thoroughly and wipe off the excess. The treat- 
ment should be made every day or every second day, according 
to the tolerance of the parts, and, preferably, in the evening, 
for appearance sake and as little exposure as possible to outdoor 
air. From six to twelve treatments usually cure the case. If 



GENERAL DISEASES. 405 

a strong solution be used, great care must be taken not to get 
the silver into the eyes. 

Epiphora, lachrymation, tearing or watering of the eyes, 
of which people frequently complain, is clue to some irritation 
or overstimulation of the lachrymal glands. The tears run over 
the eyelids onto the cheek, sometimes scalding the skin and 
destroying the epithelium. The eyes have a red appearance and 
often the edges of the lids are swollen. The mucous membrane 
of the eye usually furnishes sufficient moisture, and the lachrymal 
gland is called upon only when an excess of fluid is required, as 
when dirt gets into the eye, or the conjunctiva becomes dry and 
rough, or the terminal nerve filaments of the conjunctiva, iris, 
retina or ciliary body become irritated. The irritation may be 
caused by eyestrain, by a foreign substance, either solid, fluid 
or gaseous, by disease, or, in old persons, by relaxation of the 
eyelids, permitting the puncta to be everted. The puncta are 
the openings on the eyelids situated on their inner margin 
near the angles of the eyes and hugging the eyeballs. They 
receive the excess of fluid and convey it through tubes called 
canaliculi to the nasal ducts which open into the nose. 

The tears overflow the lids when there is an excess of them, 
or when the lids are everted, for then the fluid cannot get into 
the openings to be conveyed away. An examination should 
be made to determine whether the parts are in position, as well 
as to look for foreign substances and diseased conditions. If 
nothing wrong has been found the eyes should next be tested 
for distance and reading. 

If the trouble be due to eyestrain the proper glasses will 
correct it; if to a foreign body, its removal will effect a cure; 
if to tobacco smoke, bad ventilation, physical weakness or over- 
working of the eye, the remedy is the removal of the cause. 
If the vision is perfect and the examination has revealed no cause, 
eyestrain or a closing of the puncta or canaliculi with a gelatin- 
ous mass may be suspected and these ducts probed. As only 
an experienced oculist should undertake this, the details need 
not be given here. Closure of the nasal duct is one of the 
serious affections of the eye. 

Photophobia or intolerance of light is mainly due to the 
same causes as lachrymation and is cured by the same treatment. 

Crabs. — Occasionally pediculi pubes or crab lice are found 



406 GENERAL DISEASES. 

at the roots of the lashes, causing irritation and itching. In 
such cases a glass will reveal their presence and mercurial oint- 
ment will destroy them. 

Ulcers. — For severe ulceration of the cornea separate the 
lids and drop into the eye two or three dropperfuls of warm water 
containing all the boric acid crystals it will dissolve, then 
dry the eye of all water and secretions and drop into it two or 
three drops of a solution composed of two grains of sulphate 
of atropia to one ounce of distilled water. Repeat the treat- 
ment every four to six hours when awake, according to pain. 
The acid solution should be used warm, made so by keeping 
the bottle in a basin of clean hot water fifteen or twenty minutes. 
The dropper should be cleaned by being scalded inside and out 
each time before using it. 

Infantile Sore Eyes. — This affection attacks infants from 
the first to the tenth day after birth. The edges of the eyelids 
look a little red and swollen and may stick together, and the 
white of the eye appears somewhat red. A pearly tear may be 
in the eye although the child has not beeen crying, and there 
may be an itching sensation causing the little one to rub its 
fists in the eyes. Should the lids stick together tightly and 
some pus appear, in addition to some or all of the above symp- 
toms, there is great danger of an attack that may terminate 
most seriously, for cases of this kind, if let alone or improperly 
.treated, generally result in partial or total blindness of one or 
both eyes. 

Great care should be taken to clean the eyes and get out all 
the maternal secretions as soon as the child is born. If a 
pregnant woman has leucorrhea, commonly called whites, es- 
pecially if the secretion makes her sore, scalds the parts, all 
possible care must be taken to keep the genitals clean. They 
should be syringed daily with at least two to four quarts of 
water with enough common baking soda, not baking powder, 
added to make the water taste of it distinctly. A tablespoonful 
of carbolic acid to a half gallon of water will do as well. If the 
scalding maternal secretions get into the child's eyes in its passage 
through the canal, unless promptly and entirely removed they 
will set up the most virulent inflammation known and quickly 
destroy the eyes. The statement often made that exposure 
to strong light causes this trouble is not true. An infant should 



GEXERAL DISEASES. 407 

not be exposed to strong light too soon lest it injure the eyes, 
but this injury is to the sight itself; it does not produce a "mat- 
tery eye." 

A physician should be called at once. If the disease has 
progressed so far that the eyelids are swollen and pus is push- 
ing out between them, it will be a very hard case to manage, 
but with constant attention and careful cleansing, under the direc- 
tion of a skillful physician, the eyes may yet be saved. If but 
one eye is affected the other should be bandaged immediately, 
and kept bandaged, to prevent the secretions from getting into 
it ; and the child should be kept lying upon the same side as the 
affected eye, or upon its back, that the secretions shall not flow 
over the bridge of the nose and contaminate the healthy eye, 
and, for the same reason, it should always lie upon the affected 
side while the eye is being washed or dressed. The eyes should 
be cleaned often, frequently as often as every half hour, after 
which a little vaseline or cold cream should be rubbed upon 
the edges of the lids to keep them from sticking together and 
to soothe the inflamed surfaces. Great care should be taken 
by the nurse to prevent the poisonous secretions from getting 
into her own eyes and the eyes of others in the family. The 
cloths and cotton used must be burned, and the hands care- 
fully washed with good soap after each treatment. If the secre- 
tions scald the eyelids, cheeks or nose, these parts must be 
kept anointed with vaseline, cold cream, fresh lard, or some 
other bland salve, which must be washed off once a day with 
warm soft water containing a little soda. 

SLIGHT AILMENTS OF THE EYE. 

Slight ailments of the eye, like slight affections of other 
parts of the body, have a tendency to recover without treatment. 
A certain percentage, however, of all cases, from lack of vitality 
in the organism, will not recover spontaneously, and as we do 
not know the end from the beginning, every affection of the eye 
should receive prompt attention, but it is better to let it strictly 
alone and do nothing for it than to do anything that will injure 
the eye. 

Treatment. — There is no more useful agent in the treatment 
of its diseases than hot water, plentifully used. Aside from the 
heat, which is a quickening force to nature's lagging powers, it 



408 GENERAL DISEASES. 

dilutes and removes the poisons and filth that cause or prolong 
the diseased condition. Cleanliness, protection and rest are 
the conditions essential to recovery. To secure cleanliness use 
plenty of water that has been boiled and use it as hot as can 
be borne. To the water may be added enough salt to make 
the water taste of it, but much better than salt is a teaspoonful 
of boric acid crystals added to each pint of water. Although 
there be no secretions in the eye, the latter wash is an excellent 
one, being a cleansing and soothing disinfectant and entirely safe. 

Two teaspoonfuls of witch hazel, or listerine, or one tea- 
spoonful of carbolic acid, added to one pint of boiled water, also 
makes a good remedy; and a teaspoonful of pulverized alum to a 
pint of boiled water is useful when the eyes are itching. Cold 
applications should be used only when the hot ones do not give 
relief. 

To bathe the eyes with hot water, first boil it ten or fifteen 
minutes and let it cool to the temperature of endurance in the 
vessel in which it boiled, to make sure of cleanliness or asepsis, 
then, keeping the vessel on the hot stove, bathe the eyelids for 
five minutes, using a clean cloth that has also just been boiled. 
Let it be remembered that cleanliness is of the greatest impor- 
tance and that thoroughly clean water can be secured only 
by boiling it. It is better that the basin or pan used should 
be a new one, kept expressly for this purpose, and thoroughly 
cleansed by frequent scaldings. The whole body should be 
bathed once or twice a week and the rubbing and drying done 
by the nurse or attendant. 

Dust, some kinds of gas, and smoke, especially tobacco 
smoke, are very injurious to a sensitive eye. Keep out of the 
room while it is being swept and dusted. Washing and ironing, 
in fact all heavy work, should be abandoned for the time, as 
well as all eyework, such as reading and sewing, and the eye be 
given perfect rest. 

Eye shades may be worn with benefit to protect from the 
direct rays of light. Where the trouble is due to dirt, bright 
light, smoke, heat, cold or wind, plain ground glasses should 
be worn during the exposure, but, if the light irritates, wear plain 
ground smoked glasses, shaded according to the intensity of the 
light and the sensibility of the eye. Goggles are not good for 
the eyes, as they retain the heat and moisture of the parts, 



GEXERAL DISEASES. 409 

and the ordinary glasses found in drugstores are imperfect and 
not lit to be worn over the eyes. 

DIET. 

The diet at such times must also receive attention and 
should consist of bulky, easily digested, nutritious food, and 
such meats as pork, veal and beef should be prohibited, particu- 
larly in cataract when attended with frequent urinations, and in 
elderly people suffering from any severe injury to the eyes. 
Fruit, vegetables and cereal foods should be the principal diet, 
but where milk agrees it may be taken in reasonable quantity. 

REMOVAL OF FOREIGN BODIES. 

Pieces of steel, cinders and other foreign bodies can be 
removed, when seen in the eye, by gently rubbing over them 
a few times a piece of clean soft silk or cotton cloth stretched 
over the end of the finger, or a small piece of clean wood, as a 
lead pencil. If the mote be fastened to the eye and resists 
removal, it is better, after several attempts, to seek the aid of a 
physician than to risk doing great violence to the eye, for, as 
already explained, wounds upon the eyeball are dangerous. 

In case the object cannot be seen upon the eye, the lid 
should be turned inside out, when the mote will usually 
be found to be a little black speck sticking to the mucous mem- 
brane (inside skin) of the eyelid and can be removed in the 
manner first described, or with a little skill on the part of the 
examiner it may be scraped off with a dull knife-blade or the 
end of a toothpick. For a time after the removal there may 
be pain, as though the object were still there, because of the deli- 
cate skin having been cut. 

To turn the eyelid of the left eye inside out catch the lashes 
between the thumb and index finger of the left hand, pull the 
lid down and while it is stretched place upon it above the thumb 
and finger a knitting needle, lead pencil or some such instrument, 
and while pushing it downward and backward with the right 
hand pull the lid downward, outward and upAvard with the left, 
thus exposing the inside so that the entire surface can be 
examined. To turn the lid of the right eye catch the lashes 
with the fingers of the right hand and use the needle or pencil 
with the left hand. The patient should look down constantly 



410' GENERAL DISEASES. 

while the lid is being turned and the first examination made, but 
may assist a further examination by rolling the eyeball in various 
directions. 

TEN DON'TS. 

i. The eyes should not be poulticed. A poultice contains 
heat and moisture, which aid suppuration or rotting. An eye 
as well as a boil can be rotted by a poultice. Slippery elm, scraped 
potato, rotten apple, several folds of wet cloth, flaxseed meal, 
cornmeal, bran, all are used as poultices, and cloths wrung from 
out hot water and left upon the part until they become cool act 
as poultices. Don't use them. 

2. The eyes should not be exposed to outdoor cold for 
half an hour after bathing them with hot water. 

3. Do not look at an intensely bright light, such as the 
sun, an electric light, calcium light, a bright lamp flame, bright 
hre or snow under bright sunshine. Snow blindness is not 
uncommon. 

4. Avoid tobacco smoke. To the sensitive eye it is very 
irritating. 

5. Never use the eyes long at a time when recovering 
from a debilitating illness. 

6. Never read while lying down. The body should be 
erect when you do any close eye work. 

7. Never face a light while reading or using the eyes 
steadily at any close work. 

8. Never use the eyes more than an hour at close work 
without resting them. Unless they are good and strong they 
should be rested oftener than that. Don't fail to do it. 

9. Don't use a public wash dish and towel. They may 
often be convenient, but, by increasing his work, are of far 
more value to the oculist than to you. 

10. Do not use home treatment for an eye unless you 
know that the trouble is not serious, but seek the best medical 
advice you can obtain. 

THE LIGHT OF SCHOOLROOMS. 

In planning schoolrooms not enough attention is given to 
the requirements of vision. Correct architecture favors the 
health of the eye as well as that of the body. There should be 
the largest possible amount of light consistent with safety of 



GENERAL DISEASES. 411 

construction, and it should all be admitted from one side of 
the room. The common method of placing windows in opposite 
sides of the room is very bad, since by causing cross lights 
and perverse shadows it greatly and needlessly increases the 
strain upon the eyes of the pupils. The arrangement of every 
room should be such as to admit the light from the left side 
and rear. 

As the position of the body in school work is an important 
factor of health and perfect sight, not only during childhood but 
throughout the pupil's life, the seat and desk should be so adapted 
to his form as to make the erect position the easiest and most 
natural ; and to favor the eyes the blackboards should be on 
the right and front sides of the room and be covered with wall 
maps or light colored curtains when not in use. The walls 
should never be of dazzling white, but of some neutral tint of 
blue, yellow, gray or green, and the hangings, decorations and 
furniture should be of some light color. Of course, shades will 
be used to prevent direct rays of the sun from falling upon the 
pupils. All exposures should be to the east, south and west 
and the city school should be at a distance from surrounding 
buildings of at least twice their height. 

Were these suggestions observed in the construction of all 
school buildings the startling percentages of eye failure and dis- 
ease contracted during school life would cease to be a disgrace 
to our educational system. 

TESTING THE EYES FOR GLASSES. 

The correction of defective eyesight by means of glasses 
depends upon the principles of refraction of light by means of 
lenses. When one engaged in reading, sewing or other close 
use of the eyes prefers to hold the work more than from twelve 
to fourteen inches from the eyes he is affected with far sight 
(hypermetropia), or old sight (presbyopia), and should wear con- 
vex glasses to correct it. When he holds his work nearer than 
from ten to eight inches he has near sight (myopia), and should 
wear concave glasses. 

TO TEST FOR OLD SIGHT. 

The figures above the smallest type on the next page that 
can be read distinctly and easily in a good light at a distance of 



412 



GENERAL DISEASES. 



fourteen inches indicate the focus and size of the convex glasses 
needed. If you can easily read the smallest type here given your 
eyes do not need glasses. 

TYPE FOR TESTING THE SIGHT. 



0.50=80 

Defects of eyesight requiring correction by the use of spec- 
tacles are purely mechanical, and can be so corrected bv thi 
proper adjustment of perfectly made lenses that their effects 
will be entirely obviated. 

0.63=60 
The smallest size letters on this card should be 
read easily at tifteen inches from the eye. If you 
cannot do so you should wear spectacles. It does 
not pay to buy cheap spectacles. 

0.75=52 
They distort the rays of light, disturb the 
angles of vision, cause paiD and discomfort and 
injure the eyesight. When it is necessary to hold 
work or reading matter farther than fifteen 
inches from the eyes in order to see distinctly, 

0.88=44 
it is a sure sign of failing vision, and much 
annoyance, discomfort and pain will be pre- 
vented by having a pair of glasses fitted. Pain 

1.00=40 
in the eyes when wearing spectacles is 
usually caused either by improperly 

1.12=36 
fitted lenses, or from the centers of 
the lenses not corresponding with the 

1.25=32 
centers of the eyes. To be per- 
fect, a lens must be made with 

1.50=26 

highly polished surfaces of accu- 
rate curvatures. Only perfect 
lenses should ever be used. They 

1.75=22 

are made from the clearest 
and finestmaterial obtainable 



2.00=20 

AND SHOULD BE WARRANTED 
TO BE OF ABSOLUTELY 

2.25=18 

PERFECT CONSTRUCTION 

2.50=16 

BUY NO OTHER KIND. 

3.00=13 

THE VERY BEST 

3.50=11 

LENSES 



4.00=10 



ARE THE 



5.00=8 



CHEAPEST 



TO TEST FOR NEAR SIGHT. 

Find the farthest distance from the eyes at which para- 
graph No. 26 can be plainly seen. The number of inches between 
the page and the eyes will be about the same as the number 
designating the concave lenses required. 

TO TEST FOR ASTIGMATISM. 

Astigmatism is an eye defect whereby the rays of light de- 
rived from one point are not brought to a single focal point, 



GENERAL DISEASES. 413 

thus causing imperfect images or indistinctness of vision. If 
some of the arms in the accompanying figure appear more dis- 
tinct than the others, the presence of astigmatism is indicated. 




This defect can be corrected only by the use of cylindrical lenses 
carefully ground to the oculist's order. 

THE EAR. 

The ear is the organ of hearing and in man is composed of 
three portions : The external, the middle and the internal ear. 

The external ear consists of the pinna, or exposed part, 
and the auditory canal leading to the drumhead, the two forming 
a funnel that collects the sound vibrations, determines their 
direction and conducts them to the middle ear, or drum, which 
is a bony cavity, lined by mucous membrane, separated from 
the external ear by a delicate membrane called the membrana 
tympani, or drumhead, and containing the chain of small bones 
composed of the malleus, incus and stapes (hammer, anvil and 
stirrup), which transmit the vibrations of the drumhead to the 
inner ear. This cavity also receives the Eustachian tube in front 
connecting with the throat, and has an opening behind that com- 
municates with the mastoid process — the bone that can be felt 
by pressing upward just behind the lobe of the external ear. 
The inner ear or labyrinth consists of a bony cavity called the 
vestibule, the three semicircular canals that connect with it, and 
a bony structure in the form of a small shell called the cochlea, 
all occupied by the auditory nerve. 



414' GENERAL DISEASES. 

The hearing may be impaired by a. plug of wax, or by a bean, 
cherrystone or other foreign body in the external ear ; or by a 
thickening of the drumhead by catarrh of the middle ear; or 
from a stiffening of the joints between the ear bones, the same 
as a knee or elbow joint may become stiff. 

CAN DEAFNESS BE CURED? 

The question is often asked, Can deafness be cured? When 
of long standing it is generally incurable, but in a large number 
of cases deafness can be prevented, and the time to prevent it is 
when the ear first becomes affected. Neglect to treat the ear 
early is the principal cause of most deafness. The old idea, "Let 
a running ear alone," will, when put in practice, not only make 
deafness sure, but may cause death, for if the discharge is allowed 
to continue, not only the soft parts but finally the bones of the 
ear become involved. In some of the diseases of childhood, es- 
pecially measles and scarlet fever, ear trouble is common, and 
many persons can date the beginning of their deafness from 
attacks by these maladies. Catarrh of the middle ear results 
from cold, and though not as common as that of the nose, is of 
frequent occurrence. 

EARACHE. 

Earache, or pain in the ear, is a common affection, so com- 
mon that proper attention is not given it, and impaired hearing 
or deafness is often the result. It may be caused by exposing 
the ear to a cold wind, especially while sitting or riding, or by 
bad teeth. Such affections are classed as neuralgias. Boils in 
the ear canal are frequent causes, but the most common cause of 
all is an ear abscess called suppurative otitis media. With this 
abscess the pain is deep-seated, the hearing is dull, the ear feels 
full and hot, chilly sensations are often felt, the temperature 
ranges from 99 to 104 degrees, there is headache, and pressure 
directed inward upon the front part of the ear, or pulling the 
ear increases the pain, often causing the patient tp cry out in 
agony, and the drumhead, if it can be seen, looks red and 
bulged out. 

A child thus afflicted, by throwing its head from side to 
side and scratching the affected ear, often causes his parents to 
think he has brain fever, and there is danger of brain trouble in 
diseases of the middle ear. 



GENERAL DISEASES. 415 

Treatment. — The correct treatment for abscess consists of 
cutting a small slit through the drumhead, thus allowing the 
pus to escape. The wound made by the knife soon heals, leaving 
the membrane as good as ever, but when an abscess is permitted 
to break or rot its way through it is likely to destroy the mem- 
brane, and perhaps one or more • of the bones, which in either 
case means permanent loss of the ear. As the entire malleus 
is scarcely a third of an inch in length, and its handle, lying 
against the drumhead to receive the vibrations, is only about 
the size of a pin, the destruction of which means instant and 
incurable deafness, it can be understood that lancing an abscess 
is a very delicate operation and should be attempted only by 
one who is skillful. An artificial drumhead may be useful- where 
there is a large opening, or entire absence of the natural drum- 
head, but, as a rule, when the natural drumhead is present an 
artificial one is of no benefit and may be injurious. 

BOILS IN THE EAR. 

Pain, swelling, redness and tenderness on pressure are also 
present when there are boils (furuncles) in the ear, and some- 
times there are chilly sensations, but the pain is not as deep- 
seated and the constitutional disturbances (fever and rapid pulse) 
are not as great as when there is an abscess in the middle ear. 
These boils are generall) r brought on by picking or scratching 
the canal of the ear, as with a pin, match, toothpick or fingernail. 
When the discharge from the ear becomes offensive and con- 
tinues for several months it is likely that the bones of the ear are 
diseased. The penetrating, offensive odor is from dead bone and 
indicates a condition dangerous to life. 

Treatment. — Neuralgia (nerve pain) of the ear is relieved 
by steaming. Make a large cone from a newspaper; place its 
large end over a pot or teakettle of boiling water, and, holding 
the ear over its small end and as near as the heat will permit, 
steam the canal and drumhead of the ear until the pain is relieved. 
This usually requires from three to ten minutes. Repeat sev- 
eral times in as many hours if the pain returns. Dry the ear 
each time and put a little cotton in it to keep out the cold air. 
If the neuralgia is probably caused by bad teeth, have an exam- 
ination made by a competent dentist, who, if he finds it, will 
remove the cause. 



416 ' GENERAL DISEASES. 

If the earache comes every other day it is of malarial origin 
and quinine will cure it. From fifteen to twenty grains of it should 
be taken in five-grain doses in one day, preferably the day of 
least pain. 

If the earache be due to a severe cold; the cold must be 
treated. A hot footbath lasting ten minutes, and, where the 
head or nose is stopped up and the secretions are free, ten drops 
of the fluid extract of belladonna in twenty teaspoonfuls of water, 
one teaspoonful taken every half hour until the discharge is 
checked, will generally give relief. If the nose and head are 
stopped up and are hot, dry and feverish, aconite, in the same 
proportions and size of dose, should be used. The bowels should 
act freely. A heaping tablespoonful of the sulphate of magnesia 
(salts) should be taken every two hours until there is free action 
of the bowels. 

Heat applied to the ear, as a bag of hot water, sand or salt, 
or hot flannels, will usually give relief. It will shorten our story 
and give the suffering needed information to say that in acute, 
painful affections of the ear steam or heat may be used in any form. 
Douching or syringing the ear with hot. water is good treat- 
ment. If a fountain syringe is used, hang it but one or two 
feet above the patient's head, that the force of the stream against 
the drumhead shall not cause pain, and use from a pint to a 
half gallon of water as hot as can be borne. This may safely 
be repeated every hour until permanent relief is given. After 
the douching or gentle syringing, the canal should be dried 
carefully, using no violence,, and something warm and dry put 
over the ear until the pain returns, when the douching should 
be repeated. 

When there is much pain and heat or fever, free the bowels 
with salts, as before directed, and use the hot footbath, and if 
no relief is obtained it will be best to consult a physician. The 
chances are that there is pus (matter) in the middle ear cavity 
and that the drumhead will have to be opened to let it out. We 
repeat that the time to treat the ear and to prevent deafness 
is early in the disease. In childhood a great deal can be done 
and a very large majority of the cases can be cured. The doctor 
who advises letting the ear alone to get well itself does not 
understand ear diseases. Experience has proved that letting 
them alone is disastrous and that intelligent treatment and care 



GENERAL DISEASES. 417 

at the proper time very often prevent deafness and save many 
lives. 

Foreign Bodies. — If an insect, bean, grain of corn, or other 
foreign body, gets into the ear, do not push it in further, but go 
immediately to a competent physician. Do not try to get it out 
with a hairpin, knitting-needle, toothpick or similar instrument. 
At most only syringe with warm water, a device that is likely 
to prove effective if the nozzle is very small and the foreign 
body is so located as to permit getting behind it. An insect in 
the ear can usually be made to crawl out by filling the ear with 
warm water, the patient lying with his other ear to the pillow. 

THINGS NOT TO BE DONE. 

Do not pick the ear unless you want to make it sore. It 
should be scratched only with the elbow. If it itches intoler- 
ably an examination should be made by a competent physician. 
There is something wrong that can be righted by proper treat- 
ment. 

Do not slap a person severely upon the ear with anything 
unless you want to rupture the drumhead by a sudden com- 
pression of the air in the auditory canal. 

Do not pour oil or other substances into the ear without 
cleansing soon afterward unless you want to make a nest for 
germs and set up inflammation. 

Do not permit a child to breathe through its mouth unless 
you want it to get deaf. Mouth-breathing is a habit caused 
by some obstruction of the nose or throat, and is a fruitful cause 
of deafness by creating disorders that are conveyed by the 
Eustachian tubes to the middle ear. If necessary, to break the 
habit of mouth-breathing, bind a cloth over the mouth and thus 
force the patient to breathe through his nose. 

Do not let a discharge from the ear continue weeks or 
months, thus becoming chronic. 

Do not try everything for a sore ear or eye that everybody 
tells you. Anyone can tell you to do something, and the less 
he knows the more he can tell. It requires knowledge to sim- 
plify. But little of the right thing is needed. A little of the 
wrong thing may do great mischief. 



27 



CHAPTER IX. 
INTESTINAL PARASITES. 

WORMS. 

A great many parasites have been, found in the intestines of 
man, but so many of them occur so rarely that it is necessary 
here to consider only four classes : The Tape Worm, Round 
Worm, Thread Worm, and Trichina. 

THE TAPE WORM. 

The tape worms or cestoids belong to the genus taenia and 
constitute a numerous family. Two hundred species have been 
described, ranging from a tiny form scarcely visible, to a creature 
an inch in breadth and a hundred feet in length. They all 
live in the intestines of vertebrates, but only a few varieties have 
ever been found in man. They have been known from very ancient 
times, yet only recently has their mode of reproduction come to 
be understood. 

An egg of a tape worm never hatches in the intestine in 
which that worm lives, but must first be taken into the stomach 
of some suitable animal, where, with the aid of the gastric juices, 
it is changed into an embryo infinitesimally small, which bores 
its way into neighboring tissues, or into a blood vessel, whence it 
may be carried by the circulation to any part of the body. Hav- 
ing finally lodged, it develops into a larva, becomes encysted in the 
tissues and, unless suppuration results, may remain dormant there 
for years, with little or no inconvenience to its host, provided that 
as the cyst increases in size it does not press upon any very sensi- 
tive or vital part, and does not become very large. A cyst thus 
resulting from the development of the embryo of a tape worm 
is called a hydatid. It sometimes contains more than one embryo, 
and ranges in size from the bulk of a small pea to that of a child's 
head, but the embryo itself remains exceedingly minute. 

Measly pork is pork containing these hydatids. Heat de- 
stroys them, but the man or other animal that eats raw or only 
partially cooked meat containing hydatids becomes infested with 

418 



GENERAL DISEASES. 



419 



tape worms. The hydatids are frequently found in cattle, hogs, 
sheep, dogs and other animals, and not very rarely in man. There 
are recorded about a hundred cases of death from the invasion of 
the human brain by echinococcus, a variety of hydatid, and for 
which, when located in a vital part, especially the brain, no cure is 
known. Safely encysted in the muscular tissues of a healthy host, 
a larva may live from three to six years, then die and be absorbed or 
undergo calcareous degeneration, but if at any previous time its 
host be eaten by another animal, this embryo will become active 
and, passing through the stomach, will attach itself to the mucous 
lining of the small intestine and grow so rapidly as to become 
a full sized tape worm in from three to eight months. 




C 




Tape Worm. 
A. — Head and neck, natural size. B. — Head greatly enlarged. 
C. — Segments from the neck and middle of the body. 



The head of a large worm is often only about as large as a 
pin head, is round, and furnished with two, four, or more suckers, 
or hooks by which it clings, but has no mouth, the animal de- 
riving its nourishment by absorption, or, more exactly, by ex- 
mosis, from the intestinal juices in which it lies. It is never found 
attached except in the small intestine; the contents of the larger 
bowel will not sustain it. The very small and slender neck 
gradually broadens to the segmented body, which usually reaches 



420 GENERAL DISEASES. 

a width of one-third of an inch, or even more, and a length of 
twelve to thirty feet, and consists of from 400 to 1,200 segments or 
joints of various proportions, but generally longer than they are 
broad, though in a variety derived chiefly from fish they are 
shorter than their width, except those near the neck. Each 
joint fits into the one next behind it and each is attached to the 
next more feebly as distance from the head increases, until at the 
rear end they separate very easily and are then voided with the 
feces. Each of the oldest of these segments, up to about the four 
hundred and fiftieth from the head, is sexually mature and con- 
tains, besides both the male and female organs of generation, 
membranous sacs packed with eggs, a single segment often con- 
taining as many as 30,000 of these exceedingly minute, but per- 
fectly developed ova. It has been estimated that a single worm 
produces over 50,000,000 of them per year, also that the chances 
of development, i. e., of an egg reaching a suitable stomach in 
which to hatch, of the larva gaining a lodgment in suitable tissues, 
and later through another stomach of reaching an intestine in 
which to fully mature, are only one in many millions. With in- 
telligent care this possibility can be reduced much more, for as heat 
destroys the larva, he that eats no raw meat is not likely to ever 
be troubled with a tape worm. As much, however, cannot be said 
of the danger from the formation of hydatids. Beyond cleanli- 
ness and care to partake only of clean food and pure water, there is 
no way to guard against taking these minute eggs into the 
stomach that begins to be as effective as the prevention of their for- 
mation by protecting all domestic animals as far as possible from 
becoming infected. (See "Precautions.") 

The head is all of the worm that is essential to its life. As 
the body grows one segment after another is formed at the base 
of the neck, the oldest joint always being the furthest from the 
head, and as any number of them may be broken off without in the 
least impairing the formation of new joints, the only way to get rid 
of the worm is to get rid of its head. If let alone it may live 
for ten years, or even longer. 

Symptoms. — As sections of the worm become separated from 
the rest of the body they are voided with the feces, or passed un- 
consciously to the patient, and the first intimation that he has that 
he is carrying a tape worm may be his seeing these sections in 
his feces, or finding them in his clothing. On the other hand, 



GEXERAL DISEASES. 421 

a mature tape worm in the intestinal canal may give rise to such 
disturbances as vertigo, noises in the head, impaired sight and 
hearing, itching of the nose and anus, salivation, loss of appetite, 
alternate constipation and diarrhea, colic, sensation of weight in 
the abdomen or of something moving in the bowels, pains and 
lassitude in the limbs, headache, night sweats, palpitation, cramps, 
and sometimes even hysterical fits, chorea, convulsions and mania. 
The worm produces no poisonous secretions or excretions, and 
it is probable that nearly all the symptoms are only results of 
nervous reflexes aroused through irritation of the intestine by the 
presence of the worm. 

The symptoms are never all present in any one case, and as 
most of them may also be associated with other disorders, the 
only positive diagnosis is from finding parts of the worm. For 
this purpose, in suspected cases, examination of all the feces 
should be made, care being taken to distinguish any supposed 
segments of tape worm from shreds of mucous membrane, which in 
certain diseases are also passed with the stools. 

Let it be remembered that the really serious danger is not 
from the worm in the intestine, for that can easily be expelled, but 
from getting its eggs into the stomach, there to hatch into the larvae 
that shall find their way by the blood into the lungs, liver, eye, 
brain or some other organ and, by the development of hydatids, 
produce most serious results. Hence all examinations of seg- 
ments of a tape worm should be made with great care not to con- 
taminate the hands, and all such segments, together with the 
feces in which they are found, should be thoroughly disinfected 
or destroyed by fire. It is claimed that under favorable conditions 
the eggs may retain their vitality ten years, and then, if taken into 
a stomach, undergo development. 

Treatment. — Two days of preparatory fasting are necessary, 
during which the patient should eat very sparingly and only of 
milk, beef tea, white bread and such other light food as will produce 
little residuum. A mild cathartic, such as a dose of castor oil or 
salts, should be taken on the evening of the second day to thor- 
oughly cleanse out the bowel. The expelling medicine should 
then be taken on the following morning. Maryott says the fol- 
lowing remedy, if taken after such preparation and exactly as 
directed, will accomplish the work with absolute certainty and 
without danger to the patient. 



422 GENERAL DISEASES. 

Extract of male fern ethereal three drams. 

Pure chloroform .one dram. 

Emulsion of castor oil two ounces. 

Croton oil two drops. 

Syrup of spearmint one ounce. 

Shake thoroughly and take one-half on an empty stomach 
the morning of the third day of preparation, and after thirty 
minutes take the other half, lie quietly while the medicine is doing 
its work and when the bowels act the worm will be found in the 
stool, and the drowsiness caused by the drugs will soon pass away. 
If the head is found the patient can be sure that he is cured, 
although if very nervous or hysterical he may imagine for some 
days that he is still experiencing the old symptoms and has re- 
ceived no benefit. It is quite rare for more than one tape worm 
to occupy the same intestine at the same time. 

The seeds of the common pumpkin are also often used as an 
expelling remedy, but the preceding prescription is considered 
more reliable. If the latter is preferred, bruise an ounce of the 
seed kernels into a paste, add a half ounce of syrup of spearmint 
and two ounces of hot water, and drink as hot as can be borne, 
in the morning upon an empty stomach and after the preparation 
as before indicated. 

ROUND WORMS. 
(Ascaris Lumbricoides.) 

The round worm is the most common of all the parasites that 
infest human intestines and, next to the tape worm, is the 
largest. It is round, non-segmented, tapers toward both ends, 
but more gradually toward the head, is of a dirty yellowish red or 
light brown color, and much resembles the ordinary earth worm. 
The female is twice the size of the male, is about as large as a 
turkey's quill, and is from ten to eighteen inches long. The 
mouth is bounded by three thick lobular lips and cannot injure 
the mucous membrane of the intestines, some of the symptoms 
attributed to the worms probably being due to their acrid ex- 
cretions. 

Not more than five or ten worms usually trouble a person 
at one time, but they may be present in great numbers and a 
case is recorded in which there were 2,500 in one patient. They 
are also found in the intestines of horses, cattle and other domestic 
animals. 



GEXERAL DISEASES. 



423 




Round Worm 'natural size). 



t The female lays upward of 60,- 
000,000 eggs per year, an average of 
more than 170,000 a day, and as these 
are carried from the bowels with the feces, 
the stools must always abound with them 
when there are any worms in the intestines. 
These eggs may retain their vitality many 
years ; neither soaking in water, drying nor 
freezing injures them. It is thought that they 
must enter the stomach and pass into the in- 
testine before they can fully develop, but in 
what form, whether as eggs or as embryos, 
is not certainly known. They are probably 
taken with uncooked food, as lettuce, celery 
and fruit, or in impure water, especially that 
contaminated with privy sewage. The cases 
are more frequent in the country than in the 
city. The heat of cooking destroys the eggs. 
Round worms find their favorite home 
in the middle or lower part of the small in- 
testine, but they are prone to wander and 
to crawl into any small passage they may find, and may make 
their way into almost any part of the body connected either di- 
rectly or indirectly with the intestinal canal, as the stomach, gall 
ducts, gall bladder, hepatic ducts, pancreatic ducts, throat, nares, 
and Eustachian tubes; they may escape through the anus, and 
they sometimes crawl from the mouth and nose, provoking violent 
vomiting, coughing or sneezing. 

Symptoms. — To a healthy person a few round worms may do 
no apparent harm, but in a delicate person, or in large numbers in 
anyone, they may, in addition to most of the symptoms of tape 
worm, cause severe pain in the abdomen, dilated and often unequal 
pupils, dark and sometimes swollen eyelids, grinding of the teeth, 
foul breath, troubled dreams, etc. Finding some of the worms 
is strong indication of more inside, but a positive diagnosis can 
be made only by finding eggs in the feces, by the aid of the 
microscope. 

Treatment. — The best remedy is santonin. To a child it 
should be given in doses of one to three grains twice a day; to an 
adult in doses of three to five grains with the same frequency, and 



424 



GENERAL DISEASES. 



to both on the third day of treatment a dose of castor oil should 
be given. The tape worm remedies have very little effect upon 
round worms. As preventive measures, use care as to cleanliness 
of the hands and fingernails, partake only of well cooked food or 
fruits that have been well cleansed, and water that has been boiled 
or properly filtered, unless certain of its purity. 




THREAD WORMS. 

The thread worm, known also as the pin worm, seat 
worm and maw worm, is slender, a half inch or less in length, 
of a silvery white color, and one of the most common intesti- 
nal parasites the world over. It is most 
often found in children and the uncleanly, 
but may occur in adults and in all classes 
of people. It infests the upper end of the 
large intestine, the cecum, in great numbers, 
but is sometimes also found in the small 
intestine. The females descend to the rec- 
" turn and deposit there an immense num- 

ber of eggs, which, having reached the ground with 
the feces, and dried, are carried far and near by winds 
and other agencies. Some of these upon uncooked 
food, as vegetables and fruits, and in other ways, 
A.-Great1yTn™ged. are taken into the stomach, whence, having been 
B.-Naturai size. quickened by the digestive fluids, they pass into the 
intestine and down to the cecum, where they fully mature in 
about fifteen days. The greater frequency in children and the 
uncleanly is probably due to their scratching to relieve the intense 
itching at the anus, the fingers thus becoming contaminated with 
eggs, then borne to the mouth or used in handling" food. The 
female, having crawled from the intestine, sometimes deposits 
her eggs upon the skin and hair of the parts bordering the anus, 
and the bedding and clothing thus become infected. By sleep- 
ing with a patient, a healthy person is very liable to become in- 
fested, and the danger is increased by eating while in bed. 

When either dry or frozen the eggs retain their vitality a 
long time, but soaking in water a few days destroys them. They 
seem to hatch only when they have entered a stomach. Cases are 
recorded in which the worms were so numerous as to cover the 
walls of the cecum like fur. 



GENERAL DISEASES. 425 

Symptoms. — As long as they remain in the upper part of the 
intestine these worms cause no symptoms, but their presence in 
the rectum is announced by intense itching in the anus, some- 
times so severe as to become burning pain. This is likely to be 
most troublesome at night, and in either sex may cause abnormal 
sexual excitement, sometimes leading to masturbation. Worms 
are likely to appear in the stools. Should any doubt exist as to the 
cause of the disorder, the diagnosis can be made positive by a 
microscopic examination of the feces for the eggs. 

Treatment. — By entirely preventing self-infection, it is prob- 
able that all the worms will pass out in a few weeks and the af- 
fection thus run its course, but in severe cases treatment is 
required. As many of the remedies used are likely to be absorbed 
in the intestine before reaching the part containing the worms, 
the condition is sometimes a hard one to cure. First give a dose 
of castor oil containing a few drops of turpentine, and, when the 
bowels have been emptied, administer a large injection of strong 
suds made with castile soap and containing a little turpentine, 
the patient occupying the knee and elbow position or lying on 
his back with the hips higher than his head; at the same time all 
the rectal folds near the anus should be well washed. A little 
mercurial ointment will relieve the itching. The injections 
should be repeated from day to day until the symptoms disappear, 
and care should be taken meantime to guard against reinfection. 

TRICHINOSIS. 

Trichina spiralis is the name of a species of very minute hair- 
like worms occasionally found in an encysted state in the muscles 
of man, also in those of the cat, coon, skunk, badger, and many 
similar animals, but occurring by far the most frequently in the 
muscles (lean meat) of the hog and rat. When the young spirally 
coiled worms first appear in the tissues they are so small as to be 
scarcely visible to the naked eye, often being less than one-six 
hundredth of an inch in diameter, but, becoming encysted and 
gradually increasing in size, they attain a length of from one-fiftieth 
to one-twenty-fifth of an inch, and presently the cysts become im- 
pregnated with a limy substance that gives them the appearance 
of little white specks which can be plainly seen. 

In this condition the embryo usually remains dormant the 
rest of its life, which mav be for ten years or more, but if the flesh 



426 ' GENERAL DISEASES. 

containing it be eaten raw by a suitable animal, the embryo is set 
free by the digestive processes, enlarges to about one-twentieth 
of an inch in length, develops rapidly, becomes sexually mature 
in two days, and in five or six days the female gives birth to great 
numbers of young embryos, then in four or live weeks perishes, 
having completed the cycle of its life. In what way the young 
embryos reach the muscles far distant from the intestinal canal 
is uncertain, but it is probable that they bore their way into blood- 
vessels and are then carried in the circulation to the parts they 
are to inhabit, where, having lodged in small capillaries, they make 
their way a little distance into the tissues, and each having pene- 
trated the sheath of a muscle fiber encysts itself therein — a process 
that not only destroys the fibers, but tends to paralyze the muscles 
of which they are parts. There may be only a few of them, but 
sometimes they are present in enormous numbers. Leuckhart 
calculated that a single ounce of cat's flesh examined by him 
contained 325,000 trichina. The disturbances caused by a very 
great number of these embryonic worms in the muscles constitute 
trichinosis. 

In the encysted state they are very tenacious of life, and the 
processes for preserving meats, as salting, pickling, smoking and 
freezing, do not seem to affect them. They are, however, sus- 
ceptible to heat, and thorough cooking destroys them. In Ger- 
many and other European countries where trichinosis is very com- 
mon, the people are much given to eating food composed at least 
in part of raw or only partially cooked hashed pork. No one will 
ever have trichinosis who never eats any but well cooked meat. 

Symptoms. — At first the symptoms resemble those of cholera 
morbus, and there may be great prostration, then as the embryos 
enter the muscles there are rheumatic pains, swelling of the limbs 
but not of the joints, and contraction of the limbs. With the 
earlier symptoms there may be fever, the temperature often reach- 
ing 102 to 105 degrees. If the patient is to recover he generally 
begins to improve within three weeks. Death may result from 
diarrhea and exhaustion or from paralysis of the respiratory 
muscles. 

If only a moderate number of trichina have been introduced 
into the system there will be hardly any disturbance of health, and 
from a short time after they become imbedded in the muscles they 
are ret likely to cause any inconvenience. The more frightful 



GENERAL DISEASES. 427 

symptoms occur only when from large masses of trichina taken 
into the stomach the still larger masses of embryos enter the mus- 
cular tissues. If favorably situated a brood of these parasites act 
like poison, and a large dose of them is sure to kill. 

Treatment. — Beyond the prompt use of thorough emetics, 
cathartics and injections, very soon after eating raw pork that 
has come to be suspected, very little can be done for trichinosis. 
If the patient has vitality enough to survive the ordeal from the 
birth of the embroyos until they become encysted in his flesh he 
will recover. To this end such measures should be employed as 
tend to quiet nervous symptoms and sustain the strength as long 
as possible. 

PRECAUTIONS. 

Since the United States government began its system of meat 
inspection it has found that from one to two hogs in each hundred 
killed at the large abattoirs are trichinous. As every portion of 
the offal in such institutions is made into by-products through 
processes of which thorough cooking is a prominent part, all the 
ova, cysts and embryos contained therein are destroyed. Were 
all the meats that are used for food prepared at such places, trichi- 
nosis would soon be greatly diminished, if not entirely stamped 
out. 

Small slaughter houses with incomplete equipment, unable 
to work up all their offal, make a common practice of feeding it to 
hogs. Any hog or rat that eats scraps of refuse containing 
trichina itself becomes trichinous and, as, by the law of propor- 
tions, some of the hogs slaughtered at these places are sure to be 
infested, many of the hogs that feed upon the offal will become 
diseased. 

By a series of investigations Prof. Stiles, of the Bureau of 
Animal Industry, to whom we are indebted for many facts bearing 
upon this subject, ascertained that 55 per cent of the rats living 
upon the refuse of such slaughter houses are affected with trichi- 
nosis, and it is not probable that its proportion is smaller in the 
hogs that are fed upon the same food. Scarcely less perilous than 
the custom of feeding animal refuse to hogs is the tolerance of 
rats at slaughter houses, where 55 per cent of them become most 
dangerous agents in spreading incurable disease, inasmuch as a 
hog that eats a slaughter house rat stands fifty-five chances in a 



428 GENERAL DISEASES. 

hundred of becoming infested with trichina. While it is true that 
hogs will not always eat rats, they sometimes do, and it is likely 
that under certain conditions all would. Nor is this danger con- 
fined to the slaughter house yards, for, spreading to the neighbor- 
ing farms, these rats become a menace to the hogs of the entire 
community, and, indirectly, to its inhabitants as well. 

But trichinosis is not the only danger at the village slaughter 
house. Of each hundred hogs and cattle killed there, one or two 
is probably tuberculous; the offal of these subjects transmits the 
disease to the animals eating it, and when in turn their flesh comes 
to be used as food it is likely to transmit tuberculosis to human 
beings. 

The dog is another menace. Although he seems to be 
trichina proof, by eating slaughter house refuse he often becomes 
infected with various other parasites, of which the following are 
the most important: The Echinococcus hydatid, found in the 
liver, lungs and other organs of cattle, hogs and sheep. This 
cyst contains numerous embryos or tape worm heads, and, when 
eaten by a dog, each head becomes a tape worm, whose millions 
of eggs are scattered by the dog in pastures and elsewhere on the 
farm, some of which will find their way into the stomachs of 
domestic animals and from their flesh be transmitted to man. 
In Iceland, where each family keeps eight or ten dogs and literally 
lives with them, about one-seventh of the people have echinococ- 
cus worms ; and in Abyssinia, where the inhabitants use no privies 
and eat their beef raw, often so soon after it is killed that it is still 
warm, the prevalence of tape worm is so great as to sometimes be 
considered epidemic. 

The thin-necked bladder worm, and the Gid worm found in 
the brain of sheep, if eaten while in the larval state by dogs, 
develop into tape worms that produce numerous eggs to be scat- 
tered over farms and infect the unfortunate animal that chances 
to swallow one with its food ; and the tongue worm found in the 
viscera of cattle and sheep is transmissible in the same way to 
domestic animals and to man. 

More than to anyone else these facts are of concern to the 
farmer, for although he can, as well as his city friend, by careful 
cooking, guard against the parasitical infection of himself and 
family, the value, health and sometimes the lives of his domestic 
animals are jeopardized by the village slaughter house. It should 



GEXERAL DISEASES. 429 

be placed under strict statutory control. Xo slaughter house 
should be permitted where it will drain into a small stream or ravine 
and. by polluting its waters with disease germs, endanger animals 
and men living down the stream; its offal should never be fed to 
hogs, or left within reach of dogs, unless it has been thoroughly 
cooked ; and its rats should be destroyed. A dog should never be 
permitted to eat a rat. The farmer who dresses meat for his own 
use should burn the offal or thoroughly cook it before allowing 
it to be eaten by hogs, cats, or dogs. 

Privy sewage, the contents of privy vaults and hog manure 
should never be used on ground to which cattle, sheep and hogs 
have access, nor upon land that is to be planted to vegetables 
that are to be eaten uncooked. Raw vegetables and fruits should 
never be eaten until thoroughly washed and rinsed. 



DISEASES OF CHILDREN. 

By Theodore W. Peers, M. D. 

CHAPTER I. 

It is said that no other animal comes into the world as help- 
less, and remains in a dependent condition as long, as the human 
being. This helplessness renders it particularly liable to disease 
and accident, and we find infancy and childhood a period of 
special danger. 

Not only are there diseases to which children alone are sub- 
ject, but the disorders which may occur at any period of life are, 
most of them, very common among the little ones. With disease 
so frequent, and children unable to resist as stronger adults can, 
we should expect to find the messenger whom we all dread en- 
tering our homes most often for the babies. And such is the 
case. 

Let us suppose that one hundred infants are born to-day. 
Before one month has gone, the lives of ten will have returned 
to the God who gave them. At the end of a year we count and 
can find but seventy-four. Another year goes and there are sixty- 
six left. One-third of all the children born die before they are 
two years old. At the end of five years we count again and find 
fifty-nine. To put it differently : Of every five children only 
three reach the age of five years. 

We begin in this way, hoping to impress the gravity of our 
subject and to secure for it careful consideration. What can 
better show the importance of a knowledge of the diseases of chil- 
dren than such a plain statement of facts, unless it be to add an- 
other fact, in which the best qualified physicians agree, viz., that 
about half of ail the infants that die might be saved if their parents 
knew how to properly care for them. 

The first thing to know about disease is to know when a per- 
son is free from it, and the first thing to be known about the dis- 
eases of children is to know when a child is well. Our first con- 
sideration therefore is : 

43i 



432 , DISEASES OF CHILDREN. 

A HEALTHY CHILD. 

When a baby first comes into the world several most im- 
portant changes occur. While the mother is carrying the child 
it gets all its nourishment from her blood. Her heart sends the 
blood into its heart and body, and her lungs purify it as it comes 
back from the baby's body. Its lungs are not in use, and its heart 
does not act as it will after birth. Except in very rare instances, 
the bowels do not move before birth, neither do the kidneys. 

As soon as a healthy child is born, it begins to breathe and, 
usually, to cry lustily. In this way the lungs commence, for the 
first time, to take in air and to purify the blood, which the heart 
now begins to send into the lungs, and into the other parts of the 
body; and the baby takes up its battle of life, an individual. 

At birth a child is usually partially covered with a very soft, 
white, sticky substance called vernix caseosa. This varies greatly 
on different children. In one case the babe will be completely 
covered, and in some places, usually the small of the back, to a 
depth of nearly an eighth of an inch. Another baby will be almost 
free from it — only showing traces of it in the folds of the skin 
under the knees, in the groins, on the neck, under the arms, or in 
the folds at the elbows. 

A perfectly healthy baby is of a pinkish or red color all over 
its body; but it frequently happens that, right at first, the breath- 
ing is not perfect, or the circulation is not thoroughly established, 
and we then have a white or bluish white baby, for a day or two, 
until the normal healthy pink color comes. . 

SIZE AND WEIGHT. 

The average length of a girl baby is nineteen and a half 
to twenty and a half inches, and of a boy it is from twenty to twenty 
one inches. Dr. Holt, from a record of 1,158 infants, gives the 
average weight of girls as 7.16 lbs., and of boys as 7.55 lbs. These 
statistics are for hospital babies and are a little small. For the 
babies of those likely to read this book, I should say that 7.5 lbs. 
for girls and 8 lbs. for boys would be about right. Let it be 
remembered that these are averages and are made from healthy 
children who may have varied from 5 lbs. to 14 lbs., and that 
while averages are desirable, too much stress must not be put upon 
them. 



DISEASES OF CHILDREN. 433 

SHAPE AND PROPORTIONS. 

A baby at birth has a proportionally large head, small chest 
and big abdomen. The body is shaped something like an Qgg, 
the chest representing the small and the abdomen the large end. 
The arms are small and the legs still smaller, as compared with the 
proportions of an adult. The head is often out of shape at first, 
but, unless something is wrong, assumes the proper rounded ap- 
pearance in two or three days. A healthy baby should be covered 
evenly with fat, giving it a well rounded, somewhat fleshy 
appearance. 

If, then, your child is pink and plump, from sixteen to twenty 
inches long, weighs from six to fourteen pounds and cries lustily 
when it first comes yon may be reasonably sure that you have a 
perfect, healthy baby. 

MATERNAL IMPRESSIONS. 

The doctor or nurse usually looks the child over to see if 
there are any blemishes, and if this has been neglected attention 
should be called to it. Fortunately it is of rare occurrence that a 
baby comes into the world seriously deformed, and when de- 
formed in a way to seriously cripple its usefulness it does not, as a 
rule, live more than a few days. Red or purplish discolorations of 
the skin, commonly called birth-marks, are more frequent, but not 
disfiguring or important, unless upon the face. 

These marks are usually supposed to be caused by some 
fright or shock received by the mother while carrying the child, 
and there are numerous cases that can be best explained in this 
way, but I want to impress the fact that, where one mother marks 
her child, thirty others have each expected that her baby would 
have certain marks, only to find, at birth, that it was not marked 
at all. In my own practice perhaps a hundred women have anx- 
iously asked me: "Doctor, is the baby marked?" then described 
some event which they thought would produce that result ; but not 
one of them was right. In only one case was the child marked and 
in this one the mother had not expected it. She had rescued from 
a savage dog a little child, the left side of whose head and face was 
covered with blood. Her baby boy, born five months later, had 
a purplish red mark on the side of his face and head which cor- 
responded closely with the blood upon the injured child. 

Maternal impressions undoubtedly are sometimes causes of 

28 



434 ' DISEASES OF CHILDREN. 

malformations, therefore women should be careful, especially dur- 
ing the early months of pregnancy; but a mother so seldom marks 
her child, even after a severe shock, that it is folly to worry over a 
fright received during pregnancy. 

TRAINING. 

Suppose now that we have this healthy baby in our family, 
what shall we do with it? What a helpless little thing it is ! Our 
hearts warm toward it for this very reason, and the father or 
mother within us yearns over it. We resolve that it shall have 
better care and opportunities than we had, or at least shall have the 
best that we can give. Well, it will need care, just lots of it every 
day, and sometimes night, too. It will tire out its mother many, 
many times, and if its father is a father it will often tire him out also. 
Yes, your baby will train you whether you train it or not, and that 
suggests: What shall we do with the baby? 

Let us train it. Of course you know the meaning of "train," 
but it should have a new, fuller and more definite meaning to you 
now than ever before, so we will define it. To train is "to bring 
or raise to a definite standard, as of conduct, knowledge or skill, 
by protracted and careful instruction and practice." Another 
definition is, "to bring into a required physical condition 
by means of diet and exercise." To properly train a 
baby then is to carefully instruct it and have it do 
things for so long a time that we shall eventually bring it to the 
standard that we think a baby ought to reach. Its accomplish- 
ments should include conduct, knowledge, skill and physical con- 
dition. Our part has to do with the physical condition and to that 
we will direct our remarks. 

Some wise man has said: "Give me the first five years of a 
child's life and I will fix his religious belief." Applying this to our 
subject I say that the physical training a child gets during his 
first five years usually determines his after life. When should 
training begin? Dr. Holmes said it should commence two 
hundred years before the child is born. This statement sets forth 
a most important truth in a striking manner, and let us not forget 
that we may have a part to play in the history of the world two 
hundred or more years hence. 

But the baby we are talking about is here and our training 
of it can only begin now. It is astonishing to one, who has not 



DISEASES OF CHILDREN. 435 

been used to a baby to see how soon it can be trained to do certain 
things. Before it is a week old it knows that it is nice to be 
held and that crying will get more people to hold it. 

The foundation principle in the training of infants is regular- 
ity, for habits are thus formed, and it is largely on habit that we 
must depend. Regularity is the watchword, and the following 
order is suggestive: Nursing, sleeping, bathing, holding, defe- 
cation, temperature and exercise. 

NURSING. 

Regularity in nursing is very important for two reasons : Be- 
cause it aids and establishes proper digestion and because it helps 
to keep the flow of milk regular in quantity and quality. "Diges- 
tion is the process of so dissolving food that it can be assimilated 
by the blood and used to build up the body. In the digestion of 
the milk a child takes, it is first curdled, then gradually dissolved 
and assimilated. This process takes nearly two hours for human 
milk and almost three hours for cow's milk, hence a baby should 
not nurse at closer intervals than two hours. When cow's milk 
must be used a still longer time should intervene. 

We must think of digestion as a chemical process requiring a 
certain length of time, and remember that it should be completed 
without interruption. What would a cook say to putting a cus- 
tard pie into the oven and, when it was half done, pouring in more 
of the raw material? This is not an exact parallel, but illustrates 
the point. If food be taken at regular intervals and time enough 
be given for its digestion before' any more is taken, the stomach will 
be trained in such a way as to usually do its part. But if food be 
taken at the whim of the child, or the convenience of the mother, 
the stomach will rebel and indigestion will soon annoy the baby. 

The following table shows the frequency and average amount 
for babies at different ages : 

Age of Infant. Intervals. Times in 24 hrs. Amount per Meal. Amount in 24 hrs. 

1 week 2 hours 

2 to 3 weeks 2 ' ' 
4 " 2 " 
6 " 2^ " 

8 " 2 y 2 " 

3 to 5 months 3 " 
6 to 12 " 3 " 



Eleven 


\)/ z ounces. 


15 to 20 ounces 


Ten 


2 to 2.y 2 


20 to 25 " 


Ten 


2 to 3 


25 to 30 " 


Eight 


4 to 4^ 


30 to 35 


Eight 


5 


35 to 40 


Seven-Six 


6 to 7 


40 to 45 " 


Six-five 


7 to 8 


45 to 50 



436 DISEASES OF CHILDREN. 

When a baby is less than a month old it needs only about 
a pint of milk in twenty-four hours, but by the time it is a year old 
it needs three pints, and it is an interesting fact that the mother 
furnishes only the amount the baby needs, no matter what its age. 
The milk varies, too, in its constituents, as the baby's needs 
require, and as its powers of digestion increase. But this is true 
only when the child is nursed regularly and the mother cares for 
herself properly. If the child nurses too frequently, the milk 
becomes smaller in quantity and stronger in albuminoids, or flesh 
forming food, and is more likely to disagree with it. Irregularity 
makes the flow and quality of milk differ. We therefore see the 
importance of nursing w r ith sufficient and regular intervals. 

The flow of milk can be increased in several ways : First, by 
the mother taking large amounts of fluid, either alone or with her 
food. Water alone will increase its quantity, and but slightly 
change its quality. The best time for drinking it is a half-hour to 
an hour before, and from one to two hours after eating. If water 
is taken at meals it should be while the mouth is empty. It 
should not be used to wash down food. 

Milk will also increase the quantity of milk and, if it agrees 
w 7 ith the mother, is an excellent food for her. If cold milk dis- 
agrees it is well to try it hot, as some can digest it in that form 
readily who cannot if taken cold. Adding a little salt is sometimes 
a help, and occasionally, diluting with hot water, one part of water 
to two of milk, is an advantage. 

Coffee and tea increase the flow T , but principally on account 
of the water they contain. Cocoa or chocolate seem to have real 
milk-producing qualities and, where the mother likes it and it 
agrees with her, it is well for her to take it in place of tea and coffee. 
There are times when benefit is derived from the malt extract 
preparations. They sharpen the appetite, aid digestion and some- 
times directly increase the flow of milk. The thick extracts, such 
as Maltine, Trommer's malt, etc., have more nutritious properties 
and also aid in the digestion of starchy food. The liquid extracts 
contain alcohol and carbonic acid and are more pleasant than some 
to the taste, but have few if any digestive properties and very 
little food value. 

Few T , if any, drugs can be relied upon to increase the flow of 
milk. If the mother is not well, medicines, by increasing her di- 
gestion and blood supply, are benefits, but more by their action 
upon the general health than by their effect upon the milk. 



DISEASES OF CHILDREN. 437 

Human milk is stronger in proteids when the mother takes 
little exercise than when she is busy. If the baby's passages show 
curds., and it has colic and indigestion, the mother can, at times, 
correct the difficulty by taking more exercise. Nothing is better 
for this purpose than walking in the open air. If her milk is lack- 
ing in fat, she can increase it by using more proteid food; such as 
meat, fish and eggs. 

If for any reason it becomes necessary to "dry up the milk," 
or decrease its flow, the mother should follow the opposite course 
from that suggested to increase it, using little fluid, either as drink 
or food, and rather small amounts of food of any kind. Her 
bowels should be moved freely with Epsom or Rochelle salts. An 
ointment of a teaspoonful of tincture of belladonna, a teaspoon- 
ful of spirits of camphor and a tablespoonful of lard should be 
made and a half teaspoonful rubbed on each breast two or three 
times a day, care being used not to touch the nipples. If the 
pupils of her eyes enlarge it should be discontinued. A bandage, 
eight or ten inches wide, should be wrapped around the body 
under the arms and pinned as tightly as can be easily borne. 

SLEEPING. 

For the first three months of the baby's life it should do little 
but eat and sleep. Unless it sleeps a large part of the time, the 
probabilities are that it is not well, or at least not comfortable. 
For the first month it should sleep about twenty hours out of the 
twenty-four; at three months it should have twelve to fifteen hours 
sleep ; from three months to a year about twelve hours ; and from 
one to three years ten to twelve hours is none too much. An in- 
fant should be taught to sleep on its side, preferably the right side. 
There should be a regular time for sleeping, and this should be 
varied as little as possible. In putting it to sleep the mother 
should remember that it is a matter of habit and that she can train 
the baby to go to sleep by itself almost as easily as rocking it. 
Even were this not the case and it required much more effort to 
teach it this habit, it would still be worth while, for the saving of 
time and annoyance later. Sleep is easy for a baby, and by 
remembering two simple rules there will be little difficulty. 

First. Be regular. Put it to sleep the same way, and at 
about the same time every clay. 



438 DISEASES OF CHILDREN. 

Second. When yon attempt to put it to sleep, persevere 
until you succeed. 

Some babies require more sleep than others, hence a little 
common sense must be used as to how much each one needs. The 
easiest times for a child to go to sleep are after eating or nursing, 
after a warm bath and after a vigorous play-spell. When it per- 
sistently wakes up cross and fretful, you may be sure that some- 
thing is wrong; such as pain, too little sleep, hunger, or some 
disease. 

A baby should not sleep with its parents, but in a bed by itself; 
and when it sleeps in the daytime should be put in its own bed, 
which should always occupy the same place. If there be difficulty 
in keeping the child warm, don't depend entirely upon more cov- 
ering, but use artificial heat. 

BATHING. 

As a rule an infant should be bathed every morn- 
ing, but there are a few whom bathing seems to chill and injure. 
The mother should notice closely, and if, after the bath, the baby's 
skin and nails have a bluish color, and the feet, hands and nose 
are cold and the child breathes fast and seems exhausted, it 
will be better to simply sponge it with warm water as often as 
cleanliness requires. Let the bathing be done quickly, in a warm 
room, and care be taken not to get the baby in a draft. Every- 
thing should be prepared before it is undressed, and a thermometer 
, be used to test the temperature of the water, as the hand is not 
accurate enough. At birth the bath should be 99 degrees, and 
gradually lowered until at one month it is 95 degrees. From one 
to twelve months it should fail one degree for each two months, 
so that at one year it is 90 degrees. Some people need this tem- 
perature through life, but if the baby stands it well, and is warm 
and lively after the bath, the temperature may be reduced one 
degree every three months, so that at two years its bath is 86 de- 
grees. Some children can stand even yet cooler water, in which 
case there is no objection to gradually reducing the temperature 
in summer to 75 degrees. As babies are individuals, no absolute 
rule can be made for all. If a child thrives with a cool bath use it ; 
but if it depresses and annoys him use the warm one. 

The face should first be washed in warm water, while the 
whole body is wrapped in a flannel blanket. The scalp should then 



DISEASES OF CHILDREN. 439 

be washed with castile soap and dried with a soft towel. Next, 
sponge the body and extremities with a soapy sponge, using 
special care to cleanse the folds at the neck, under and about 
the arms, and the genitals and groins. The child should then be 
lowered slowly and gently into the bath tub filled with clear 
water, and, after the soap has been washed off, taken out, care- 
fully rubbed and dressed, care being used to have the clothes 
warm. If the skin shows a tendency to soreness a dusting powder 
should be used, composed of equal parts of powdered corn starch 
and boracic acid. The morning is the best time for this bath and 
it should be given regularly at about the same hour each day, 
after which the child should be nursed and put to sleep. 

HOLDING. 

One of the delights of motherhood, and one of the 
greatest favors to visiting admirers, is holding the baby. 
Let this be done with care. Xever lift a baby by its arms extended 
over its head, and especially do not lift it by one of its arms. 
If you must kiss it, let it be upon the cheek or forehead or, bet- 
ter still, upon the hand, never upon its lips. 

DEFECATION. 

This is a subject of so much importance that it must be 
considered. Many a patient is forced to consult a doctor be- 
cause this matter did not receive proper attention in infancy. 
Just as a stopped-up sewer brings sickness to a household, so 
constipation brings illness to an individual. If the waste matter be 
not excreted it will be absorbed and poisons be drawn into the 
blood. As the best cure is prevention, the best remedy for consti- 
pation is regularity, from infancy, in emptying the bowels. 

It is surprising how quickly some babies learn to attend 
to the calls of nature, and how regular they become by proper 
training. They have been taught to indicate their desire to 
evacuate the bowels when only four months old, and the added 
comfort and lessened work for the mother are so great that she 
may well make the effort necessary to train her child. It should 
be placed upon the chamber soon after its morning meal and, if 
the bowels are not soon emptied, a pencil of soap inserted in the 
rectum, or a rectal injection given of two teaspoonfuls of a mix- 
ture of one part glycerin and two parts water. Either treatment 



440 - DISEASES OF CHILDREN. 

is likely to cause prompt action. The soap pencil may be made 
from a piece of soap two inches long by trimming it into a taper- 
ing cylinder, whose small end is one-fourth inch and large end 
one-half inch in diameter. 

The training of the bladder is not quite as easy and im- 
portant, but is desirable, and efforts in this direction are often very 
successful. Here, as in the former case, regularity is the prin- 
cipal factor in the training. 

TEMPERATURE. 

Babies are very susceptible to changes in temperature, espe- 
cially to cold, and many mothers make the grave mistake of sup- 
posing that when a child is cold they can warm it by adding cov- 
ers. Let it be remembered always that a cold baby should never be 
warmed in that way, but in every case by applying heat. It is 
true that a baby's circulation is active and that at times it ac- 
quires warmth more rapidly than an adult, but this is not always 
true and, as a child takes cold so readily and its colds are liable 
to result so seriously, great care should be taken to keep the baby 
warm. 

Here again regularity is the key note. Keep the baby and 
the room at as even temperatures as possible; that of the latter, 
when artificial heat is employed, at from 70 degrees to 75 de- 
grees. It is not best for a child less than a year old to sleep in 
a cold room ; but if it must do so some artificial heat should be 
placed in the bed, as a hot water bottle, a hot brick, or a bag of 
hot sand or salt. Colic is often caused in very small children by 
cold, and is immediately relieved by thoroughly warming them. 
The feet should be uncovered and well warmed by the fireplace 
or stove. Many teas are used for colicky babies, some of which 
have medicinal value, but the relief afforded by them is chiefly due 
to their being given warm. A warm baby is almost always a 
happy baby and one easy to care for and, if kept uniformly warm, 
digests its food better and grows faster than a cold one. 

EXERCISE. 

Few people pay any thoughtful attention to exercise for their 

little ones, yet, how important it is that they have the strong, 

healthy bodies which can be secured only through proper and 

systematic exercise. This is not the department in which to 



DISEASES OF CHILDREN. 441 

give extended and minute directions as to its kinds and times, 
but a fewgeneral statements may not be inappropriate. 

Exercise should be taken as largely as possible in the open 
air. If taken within doors, the room should first be thoroughly 
aired and, if not too cold, the windows should be open during 
the exercise. Exertion should be sufficiently vigorous to bring a 
healthy glow to the body, but not to tire, and never violent enough 
to cause exhaustion or strain. It should be regular, too, for it is 
the everyday work that tells. Many start vigorously, doing even 
too much, perhaps, for a week or two, then give it up entirely. 
The correct plan is to spend a certain definite time every day 
in exercise, keeping it up by the year. It is surprising what an 
improvement, in a child unaccustomed to it, fifteen minutes daily 
will soon make. The exercise should be varied and as pleasant 
as possible. It is far better if regarded as fun than if thought a 
task. 



CHAPTER II. 

ARTIFICIAL FOODS. 

Of the many parts of our subject, this one is of the very 
greatest importance. There is more sickness and loss of life 
among" infants because of improper food and feeding than from 
any other cause, if not from all other causes combined. Not 
only this, but in every illness from any cause, feeding is a most 
important factor of the treatment, often turning the balance 
between life and death. We have spoken of maternal feeding 
and shown how desirable it is for a mother to nurse her babe, and 
that it is better, not only for the child, but for her, to nurse it, 
at least a few times a day, if her milk is good, even if artificial 
foods must also be given. It now becomes necessary to show 
how a child should be fed, if, for any reason, the mother is not 
able to nurse it. So many infant foods are on the market, each 
pictured as the best, and so many different kinds will be recom- 
mended by well meaning friends, it is very necessary to be in- 
formed and able to act intelligently in this matter. 

For convenience we will consider artificial foods as of five 
classes : 

MILK. 

i. Milk always contains about the same materials, no mat- 
ter from what animal it comes, the main difference being only one 
of proportions. There are several animals whose milk is more 
like human milk than is that of the cow, the mare, ass and goat 
being among them; but cows' milk is so much the easiest to ob- 
tain it is most often used. The following is an average analysis 
of human milk and that taken from the cow: 

Reaction. Fat. Sugar.. Proteids. Salts. Water. 

Cows' milk acid 3.50 4.30 4.00 0.70 87.00 

Human milk... alkaline 4.00 7.00 1.50 0.20 87.30 

From this comparison we see that the main difference be- 
tween cows' milk and human milk is that cows' milk has TOO 
MUCH OF THE PROTEIDS AND NOT ENOUGH SUGAR. 

442 



DISEASES OF CHILD REX. 443 

We put this fact in capitals that it may not be forgotten, as it is 
the basis of all the modifications of cows' milk to make it fit for 
infants' food. Of the two ingredients, the proteids are, decidedly, 
the hardest to manage. They are the tissue-forming and strength- 
giving part of food and therefore valuable, but if present in too 
great quantities are not digested, and form irritating curds in the 
infant's stomach and bowels. This proteid material differs in 
the two kinds of milk, not only in quantity but also in quality. 
The formation of curds is the first step in the digestion of milk, 
and takes place upon its admixture with the acid of the stomach. 
This acid has been found to closely resemble hydrochloric acid. 
Now, if we add a little dilute hydrochloric acid to cows' milk we 
will find that it produces a hard curd (the so-called cottage cheese 
or schmierkase of the Germans) ; but if we add the acid to hu- 
man milk it produces a curd consisting only of fine flakes, easily 
broken up and not one-fourth as great in amount as that from 
the cows' milk. We must understand, too, that not all of the 
proteids form curd; part of them remain in a soluble condition, 
and are therefore much more easily digested. 

The question now arises : How can we modify cows' milk 
so that it will be good food for the baby? There are four ways: 

1. Dilute with water and add sugar and cream. 

2. Use whey with sugar and cream. 

3. Digest the proteids with pepsin, pancreatin or papoid. 

4. Dilute by adding some cereal or lime water to prevent a 
firm or hard curd. 

No. 1. Dilution. — Various degrees of dilution have been sug- 
gested, most of which have worked well with some babies. If we 
add to a measure of cows' milk an equal amount of water (boiled 
and strained), we have in the mixture about two per cent of pro- 
teids, which is a little more than the average found in human milk, 
but in reducing the proteids we have also reduced the amount of 
sugar and cream (fat) ; hence we will have to add enough of these 
ingredients to get the right proportions. They can be very 
nearly obtained by using the following rule : One-half pint of 
fresh milk ; one-half pint of water, one and one-half tablespoonfuls 
cream and two heaping teaspoonfuls of milk sugar. This is proper 
for a child six months old. For a younger child more water should 
be added, and as it grows older the water may be lessened, but 
not verv much, as most infants thrive best when the milk is 



444- DISEASES OF CHILDREN. 

diluted as indicated. Whenever small pieces of curd appear in 
the stools, they mean indigestion or too much proteids, and in 
either case the proteids should be lessened by adding more wa- 
ter. If the child be constipated, the addition of cream will 
often aid in correcting the difficulty. 

It may be well to mention the necessity of procuring good 
milk. Cows' milk varies greatly, and while one cow gives a milk 
easy of digestion, that given by another may be difficult. The 
digestibility of any particular milk may be learned either by chem- 
ical analysis or by its effect upon the child. As an analysis is 
expensive most people rely upon the effect. There is a widespread 
belief that the milk from one cow is better for a child than is the 
mixed milk from a herd, but quite as generally it is believed 
by the profession that the mixed milk is preferable. 

My own opinion is that if the right cow can be obtained 
it is better to have milk from her alone, but if one cow's milk 
that agrees with the child cannot be found, it is of course better 
to use milk from the herd. Milk fresh from the cow is decidedly 
easier to digest than when it has stood even one hour. A baby 
will at times retain and digest milk if the cow be milked every 
two hours and the milk fed to it at once, when, were the milk 
allowed to get cold before being fed, the child would vomit very 
soon after taking it. 

The "stoppings" contain more cream and less proteids than 
either the first milk or mixed milk, and where it can be done 
it is an excellent plan to keep the last quart separate for the baby. 

No. 2. Use of Whey. — The whey of cows' milk contains 
little proteids, but as it is the proteids that usually disturb diges- 
tion in children, we sometimes use whey in feeding them, to 
tide over a dangerous period. A teaspoonful of sour wine is 
stirred into a half pint of fresh milk and when it has stood half 
an hour the curd formed is strained out. To the whey thus 
obtained are added a teaspoonful of milk sugar (cane sugar is 
not good) and a tablespoonful of cream; then it is warmed to 
100 degrees and fed with a bottle or spoon. Sometimes a table- 
spoonful of fresh milk is added to supply the lacking proteids 
and the proportion gradually increased as the child's digestion 
improves. 

No. 3. Digestion of Proteids. — We may take care of the 
casein (one of the proteids) in milk by wholly or partially 



DISEASES OF CHILDREN. 445 

digesting it. This is done by putting into a bottle a pint of 
fresh cows' milk, one-fourth of a pint of water and a powder 
consisting of five grains of extract of pancreatin and fifteen 
grains of bicarbonate of soda ; then placing it in a pail of 
water at no degrees, or as warm as the hand can comfortably 
bear. The milk begins to digest at this temperature and the 
process can be carried as far as the needs of the infant require. 
For one in ordinary health fifteen minutes is usually long 
enough. If digested more than this the milk becomes bitter 
and the child refuses to take it. The bitterness is due to the 
formation of peptones, and although it gives it a disagreeable 
taste it makes it easier to digest. If the milk be kept in warm 
water two hours the casein will be completely digested and the 
milk will not curdle when an acid is added. This process is a 
valuable one in certain emergencies and for a child under three 
months of age, but there is danger that the stomach so fed 
will not have enough to do to keep up the growth of its digestive 
powers. This artificial digestion can be stopped at any point, 
either temporarily, by placing the milk upon ice, in which case 
the digestion of casein can be resumed by warming the milk to 
80 degrees or more, or permanently, by heating the milk until 
it boils, thus destroying the digestive ferment. 

For convenience digestive tablets and peptonizing tubes have 
been devised, and can be procured at the drug stores, containing 
the soda and extract of pancreatin ready for use. Seeing the 
utility of this process, Fairchild, Bro. & Foster have prepared a 
peptogenic milk powder composed of the above ingredients with 
milk sugar added. This makes a preparation very much like breast 
milk and, in my hands, has proved a most excellent food for an 
infant less than five months of age. Directions accompany each 
bottle of the powder. 

No. 4. Cereals and Lime Water. — Cereals are the foods 
obtained from various kinds of grain, such as wheat, oats, rice, 
barley and corn, and are made up very largely of starch. The 
term is also applied to the starchy foods derived from potatoes, 
arrowroot and sago. Until a child is from three to six months 
old he cannot digest starch and it should not be given him. 
It has been learned that milk mixed either with starchy material 
or with lime water will not curdle into as hard lumps, while 
being digested, as milk will if taken pure, and this principle 



446 - DISEASES OF CHILDREN. 

is often employed in preparing food for babies. The materials 
most often used for this purpose are oatmeal, barley meal, flour 
and corn starch, and they must always be very thoroughly cooked. 
Upon a heaping tablespoonful of any one of these,, preferably 
oat or barley meal, pour a quart of cold water, then boil steadily 
for at least two hours, adding water from time to time, so that 
at the end there shall still be a quart. Strain through absorbent 
cotton or cheesecloth. Equal parts of this water and milk, with 
sugar and cream added as in No. i, make an excellent food 
for infants over six months old. 

CONDENSED MILK. 

This is made in two ways. The oldest process is that of 
adding sugar and boiling the milk, then evaporating it to a 
semi-solid condition, the object of the sugar being to keep the 
milk from fermenting quickly after the can is opened. In recent 
years certain manufacturers have left out the sugar and simply 
evaporated the milk to a thick liquid consistency. 

Much has been written about condensed milk as a food 
and there seems to be a great fondness for it among the laity, 
but chemical analysis shows it to be lacking in fat and to have 
too much sugar in proportion to its fat and proteids. It is 
evaporated to about one-fourth the weight of the milk, and 
as about twelve parts of water are usually added to one part of 
condensed milk, the result is the same as adding three parts of 
water to one part of fresh milk. 

Although the sugar is liable to ferment, it is easy for a baby 
to digest, and a baby fed upon condensed milk usually gets fat 
and has a fair and clear complexion, leading the mother to think 
that her child is doing well ; but doctors know that such chil- 
dren are especially liable to disease, and when sick are less likely 
than other children to recover. Dr. Holt says that he never 
saw a child that was raised upon condensed milk that did not 
show some signs of rickets. 

Sweetened condensed milk is therefore not a suitable food 
for babies. It serves a very useful purpose when, for a time, an 
easily digested food is needed, as when the child is sick, or when 
one is traveling, or cannot obtain good cows' milk, or when the 
baby is less than two months old ; even then cream, if it can be 
obtained, should be added. 



DISEASES OF CHILDREN. 447 

Condensed milk without sugar is little more than sterilized 
cows' milk evaporated to one-fourth its weight ; hence, after 
adding three parts of water it should be treated as was directed 
for cows' milk. Because of its liability to ferment in hot weather, 
condensed milk with sugar is better diet for winter than for 
summer. 

MISCELLANEOUS FOODS. 

Under this head we will speak of the prepared foods, which 
are principally of two kinds. 

First. The Cereal Foods Partly Digested by Heat. — By 
cooking cereals a long time at a high temperature the starch is 
changed and rendered more easily digestible. Taking advan- 
tage of this fact, manufacturers have prepared and placed upon 
the market such products for babies' food. Mellin's, Ridge's 
and Imperial Granum belong to this class. Aside from the fact 
that some of them contain starch, their greatest deficiency is 
the small amount of fat they contain. Cream should therefore 
be added and they should be reserved for children over six 
months of age. 

Second. Cooked Cereal Foods with Condensed Milk Added. — 
The addition of condensed milk slightly increases the amount of 
fat, but there is still a deficiency. Malted milk and Xestle's food 
are of this class. 

A preparation has been introduced recently from Germany, 
called Gardner's Mother's Milk, which is an attempt to so 
manipulate cows' milk as to make it like mother's milk. 

We are sometimes compelled to exercise all our ingenuity 
to find a food that the baby can digest. Many things besides 
the above have been tried with varying success. 

Beef juice, obtained by cutting lean steak into small pieces 
and warmed enough to thoroughly heat it through, but 
not to cook it, then pressing out the juice with a lemon 
squeezer or press, is sometimes very useful. 

The white of an tgg beaten up in a glass of water is valuable, 
especially where vomiting is persistent. 

Whey, made by adding a teaspoonful of sour wine or vinegar 
to a cup of milk, and straining, is also used. Unfermented grape 
juice is often very grateful, and koumiss is also good at times. 

The subject of infant feeding is a very large one, and cannot 



448 - DISEASES OF CHILDREN. 

be treated exhaustively here; we have only attempted to 
give some general principles and to be specific enough to enable 
mothers and nurses to feed correctly in emergencies, but they 
must remember to consult a physician when possible as to which 
food is most appropriate for each child. 

As already shown, digestion is a chemical process greatly 
aided by taking the food at proper intervals and in proper 
quantities. It should also be understood that the kinds of food 
must vary but little, and when the kind that agrees with the baby 
has been found, it should be relied upon and not changed except 
for cause. There may be a little variety occasionally to whet 
the appetite, but this is generally best done by a relish or des- 
sert, given after the regular meal and in small quantity. By 
this method a child may be trained not only to eat the proper 
food but also to enjoy it. The numerous patients who come 
to the doctors complaining that they cannot eat this, that and 
the other wholesome and nutritious article of food, prove in 
so doing that when children they were not properly taught 
what to eat. Its individual taste is not the infallible guide to 
what the child needs. With proper training it may be taught 
to relish and enjoy most of the staple foods. 

ADMINISTERING FOOD. 

A few things should also be said in regard to the adminis- 
tration of food. Absolute cleanliness of food and of the utensils 
used in preparing and giving it is of the first importance. In 
country districts where the cow can be properly cared for, 
and the milk can be cooled quickly and kept cool, sterilization 
is not necessary unless the baby is sick. In a large city it is 
impossible to get absolutely fresh milk, hence all milk used 
there for babies should be sterilized. This may be done by 
boiling in a double kettle twenty minutes, or Pasteurized by 
keeping it for thirty minutes at a temperature of about 165 
degrees Fahrenheit. The latter process is to be preferred, as 
it does not alter the milk in taste and chemical composition 
as much as the other method. After having been thus treated, 
the milk must be kept in air-tight vessels, as fruit jars, in a cool 
place until used. 

Boiling water is the best cleanser and all utensils used for 
the babv should be boiled. Washing: in warm water does not kill 



DISEASES OF CHILDREN. 449 

the germs which cause disease. The nursing bottle should be 
rounded inside to leave no corners where the food can 
collect and prevent easy and thorough cleansing. Alter it has 
been used it should be boiled, then filled with a solution either 
of bicarbonate of soda, borax or boric acid, a teaspoonful to 
the quart of boiled water. A rubber tube should never be 
used and the nipple should always be a plain one. Several 
nipples should be procured at one time, and, after scalding, 
should be kept in one of the solutions above mentioned. 

As it is best for the baby to take its food slowly, select 
nipples with small openings that will require ten minutes for 
it to get its meal. A little patience and tact will usually get 
it to nurse a bottle, although it may refuse at first. There 
is no objection, however, to feeding with a spoon. It is better 
not to give it from a cup, for, because of gulping it down too 
fast, the child is more likelv to be troubled with indio-estion. 

DENTITION. 

Dentition, or cutting of teeth, was once regarded as the 
principal cause of a number of diseases, especially diarrhea, con- 
vulsions, fever, and, at times, affections of the lungs; but, by the 
best authorities, it is now regarded as only occasionally a cause 
of disease. It may lead to restlessness, fever, indigestion, or even 
to convulsions, but in most cases is attended by no special symp- 
toms ; and there is danger that, from regarding it as a cause, the 
serious and real causes will be overlooked ; hence, always inves- 
tigate these diseases carefully, although the child be teething at 
the time. 

At birth the teeth are enclosed in sacs, occupying depressions 
in the jaws, and, as growth progresses, they pierce the gums. 
These first teeth, called deciduous or milk teeth, are twenty in 
number and, although they may vary in the time, they rarely 
vary in the order of their coming. The following is an average 
of the order and time of their first appearance : 

Number. Name. Months after birth. 

2 Lower incisors 6 to o 

4 Upper incisors 8 to 12 

2 Lower lateral incisors 12 to is 

4 First molars I2 to I5 

4 Cuspids, also called canines 18 to 24 

4 Second molars 24 to 30 

29 



450 DISEASES OF CHILDREN. 

There are many variations to this rule. The teeth may be- 
gin to appear during the third or fourth month, or may be de- 
layed until the eleventh or twelfth month. In a weak, poorly 
nourished child, teething is nearly always delayed. 

The teeth may appear without any noticeable disturbance, but 
usually there is redness and swelling of the gums and increase of 
the saliva. The child wants to bite something hard and may want 
to keep its fingers in its mouth ; it may become restless and fret- 
ful, and sleep less than usual, and there may be loss of appetite. 
There is often constipation, and there may be diarrhea, either of 
which conditions should receive attention. If a child be forced 
to take more food than it desires, attacks of indigestion, vomiting 
or diarrhea may follow. In some cases there is high fever and 
a hot, dry condition of the mouth and gums. Earache may also 
accompany the teething stage, and gradually leave as the teeth 
appear. These symptoms usually last two or three days, then 
subside as the teeth make their appearance, but they may last a 
week, and, if severe, a physician should be consulted. In some 
cases that have not received proper attention convulsions may 
occur, for which a hot mustard bath should be given and a doctor 
called immediately. 

Children should not be exposed during the period of 'denti- 
tion, for they are then very susceptible to cold, and only a little 
exposure may result in bronchitis or pneumonia. The gums very 
rarely need lancing, and when required it should be done only 
by one, who is skillful. 

Care of the teeth should begin in infancy. As soon as they 
first appear, the mother or nurse should cleanse them daily with 
a soft linen or muslin rag, and as soon as they have all appeared 
a small, soft brush should be used. It should early form the habit 
of caring for its own teeth. It must not be allowed to suck its 
fingers, as this habit may cause the teeth to assume an abnormal 
position. The constant weight of the thumb, or fingers, in the 
mouth may cause the lower front teeth to point in, and force 
the upper ones outward, thus causing an unsightly deformity 
of both jaws. 

Decay of the teeth, whether of the temporary or permanent 
set, should receive prompt attention. A child two years old 
should have its teeth examined by a dentist and treated if neces- 
sary; after which they should be examined every six or eight 



DISEASES OF CHILDREN. 451 

months and kept in repair until they drop out, and are replaced 
by the permanent set. Dentifrices, except as recommended by a 
reliable dentist, should not be used. 

The permanent teeth begin to appear about the sixth year, 
number thirty-two and come about as follows : 

First molars, at about 6 vears of asre 

Incisors, at about 7 to 8 years of age 

Bicuspids, at about 9 to 10 years of age 

Cuspids, at about 12 to 14 years of age 

Second molars, at about 12 to 15 years of age 

Third molars, at about 17 to 25 years of age 



CHAPTER III. 

DISEASES OF THE MOUTH. 

Disease of the mouth, of an inflammatory character, is called, 
in medical works, stomatitis. There are five forms of this disease 
which we will describe: (i) Catarrhal stomatitis; (2) Ulcerative 
stomatitis ; (3) Aphthous stomatitis ; (4) Noma, or gangrenous 
stomatitis; (5) Thrush. 

CATARRHAL STOMATITIS. 

This begins with reddened patches in the mouth, 
which is apt to spread until the entire mucous mem- 
brane of the mouth and tongue is involved. The mouth be- 
comes swollen, hot and sore, and soon raw places appear which 
are painful and irritating. At first the mouth is dry, but soon the 
saliva flows freely and, with babies, the drooling is often excessive. 
The excreted fluid is acid in its reaction and so irritating that the 
skin around the mouth is made sore by it. If the inflammation 
is not soon arrested ulcers begin to appear and the ulcerative 
form of the disease follows. 

The usual causes of the catarrhal form are lack of cleanliness,, 
bad teeth, irritating food and the various things covered with 
paint or other irritating material which a baby is likely to put in 
its mouth. 

Treatment. — Only simple remedies are needed. Borax wa- 
ter, one teaspoonful of borax to a pint of water, used on a swab is 
usually sufficient. One end of a stick, the size of a slate pencil and 
six or eight inches long, is wrapped with a little piece of soft 
linen or absorbent cotton and dipped in the solution, or better, a 
little of the solution is poured over it, and with this the sore mouth 
is gently, but thoroughly washed. This should be repeated every 
one to three hours. In some cases alum is better than borax. 
Listerine, euthymol and borolyptol are proprietary articles which, 
at times, are useful. 

452 



DISEASES OF CHILDREN. 453 

ULCERATIVE STOMATITIS. 

This form usually occurs after the child has teeth, .and is 
likely to be confined to the gums. They become red, swollen and 
sore and bleed very easily. The gums soften, the teeth loosen, 
and the child becomes irritable and sometimes feverish. The 
glands about the neck may become enlarged and sore, or may 
even suppurate. This form of the disease usually requires con- 
stitutional treatment as well as local applications. 

Treatment. — A half teaspoonful of Parke, Davis & Co.'s syrup 
of the hypophosphites three times a day, for a child four years 
old, is useful. It is of the first importance that the ulcers be kept 
clean by frequent rinsing with one of the preparations above 
mentioned. At times an astringent powder, composed of one 
part powdered alum to three parts of powdered boric acid or bis- 
muth, is useful. 

APHTHOUS STOMATITIS. 

Aphthous Stomatitis, or canker sore mouth, is characterized 
by from one to twenty small ulcers on the mucous membrane of the 
mouth. They are usually round, but sometimes oblong, and vary 
in size, from that of a pinhead to a pea, are of a yellowish white' 
color, looking as if a little piece had been dug from the membrane, 
leaving a small hole, and are quite painful. The mouth becomes 
hot and tender, and the saliva is increased, acid and irritating. 

This trouble is usually caused by indigestion, and by certain 
foods, as tomatoes and articles prepared with vinegar. It often 
occurs during dentition, but may come at any age. 

Treatment. — Regulate the diet, particularly as to sour food, 
sugar and starchy articles. A plain diet, limited in amount, will 
usually effect a cure in a week or so. If there is constipation, a 
dose of Epsom salts, taken in hot water before breakfast, is ad- 
vised. One-tenth grain calomel triturates, one taken every hour 
for six to ten hours, and, if the bowels do not move freely, followed 
by salts the next morning, are very efficient. For local application, 
a solution of chlorate of potash, alum, sulphate of zinc, or sul- 
phate of copper, is useful. 

NOMA, OR GANGRENOUS STOMATITIS. 

This is a dreadful disease but, fortunately, is very rare. As 
a rule it occurs only in children already weakened by measles or 



454 DISEASES OF CHILDREN. 

some other disease, and therefore unable to resist as a healthy 
child would. It appears on the inside of the cheek as a sore lump 
about as large as a pea. This rapidly enlarges, turns black and 
begins to slough. The odor is extremely offensive and the dis- 
charge from the sore very irritating. All the tissues of the cheek 
are soon involved, and a hole made, through which the teeth can 
be seen. As it progresses, all the tissues of the mouth are at- 
tacked, the gums drop away, the teeth come out and at last death 
closes the scene, unless the progress of the disease is stopped. 

No one, not specially fitted, should attempt to treat this 
disease. The child should be taken to a good physician as soon 
as the malady is recognized. With the most skillful over half 
of the cases prove fatal. 

THRUSH. 

This is a disease caused by fungus, growth. It formerly was 
more common than it is to-day, unless the name was also given to 
other mouth diseases. It is found only in young, sickly babies, 
who are poorly nourished. As long as a child is reasonably well, 
nature protects the mucous membrane of its mouth from growths 
of this kind. It is of vegetable character, appears as a thin, white 
covering on the membrane of the mouth, very much as mold ap- 
pears on food that has long been left in a damp, warm place, and 
spreads in every direction. At first, while upon the surface 
of the membrane, it can be brushed off, but it gradually makes 
;the membrane sore and, if neglected, finally destroys it. It may 
descend into the stomach, and even into the intestines, in which 
case it is said to have ''gone through the baby." There is a com- 
mon belief that such an occurrence is surely fatal, but it is not. 

Treatment. — The treatment of thrush is both local and con- 
stitutional. 

Everything possible must be done for the general health of the 
child. Great care must be used to secure for it a good nourishing 
food that it can digest. Cod-liver oil should be given internally and 
it is a wise plan to bathe the child in it two or three times a day, 
rubbing until absorbed it disappears in the skin. A good tonic, 
as the hypophosphites, is also useful. 

For local treatment, chlorate of potash has the most indorsers. 
A solution, in the proportion of one teaspoonful of it to a pint of 
water, is used every hour or two to wash the mouth. Boro-gly- 



DISEASES OF CHILD REX. 455 

cerite is also good for this purpose. Some mild antiseptic solution 
should be used gently and often. 

DISEASES OF THE STOMACH. 

The diseases of the stomach and intestines of children are 
very closely allied, and we cannot make their diagnosis as clearly 
and closely as to exact location and condition, as we can in adults. 
Fortunately, this is not usually necessary, as the treatment for 
either condition is similar to that for the other. Many babies lose 
their lives from stomach and intestinal diseases, and this, too, 
although it is possible for the mother to treat her child success- 
fully by doing the right thing at the very beginning of the symp- 
toms. Of course, it is not safe for her to trust her own skill too 
far, lest the disease finally get such headway as to baffle even the 
most skillful physician. The instructions I shall give are for emer- 
gency cases, where it is impossible to get a physician, or where 
the symptoms are mild. If, however, relief is not at once ob- 
tained, it is better to consult a physician, when one can be ob- 
tained. 

ACUTE DYSPEPSIA. GASTRALGIA. GASTRIC FEVER. 

This is an acute affection of the stomach, which is quite com- 
mon among babies during the summer months. It is usually 
caused by improper feeding, combined with teething, hot weather 
and fretfulness. It comes on with vomiting, which is soon followed 
by fever. As a rule the baby is in distress and pain for a few min- 
utes to an hour or more before it vomits, and the pain often con- 
tinues an hour, or longer, afterward. The pulse is quick and 
usually the abdomen is full. It is not a severe affection and is 
likely to last but a few hours to a few days, unless it is neglected 
and the intestines become affected. 

Treatment. — The treatment consists in regulating the baby's 
food, and o-ettinof rid of the irritating matter in the stomach. 
For a child over one year of age, scalded milk, barley water and 
milk, white of an egg in boiled water, or boiling milk poured over 
a cracker, then covered and allowed to steam for five or ten min- 
utes, are proper foods. They should be given in small quantities 
and not too often, and not at all if they excite vomiting. A 
mother is sometimes distressed because her baby "has not eaten 
a thing," or, "has thrown up everything it has eaten all day." 



45G ' DISEASES OF CHILDREN. 

She seems to be afraid it will starve ; but a moment's thought 
should quiet her fears. We have authentic records of persons liv- 
ing forty days without food, and many have gone a week without 
taking nourishment, and that, too, when they were already weak 
from sickness. If, then, it is possible to go from one to six or 
seven weeks without food, we may feel perfectly at ease when the 
baby goes without food from twelve to forty-eight hours. In- 
deed, one of the best treatments possible in stomach and bowel 
diseases of children is to have them s go a day or two without 
food. In regard to remedies, there are no specifics, that is, no 
medicines that will always cure, or that it is always best to give. 
If the child vomits freely and is relieved, no further treatment is 
necessary, but if it continues to strain and throw up sour or bad 
smelling matter, it is well to give it warm water, containing a lit- 
tle soda and peppermint. To a half teaspoonful of soda, a tea- 
spoonful of sugar, and from three to ten drops of essence of pep- 
permint add a teacupful of warm water, and have the child take 
all it can. This usually empties the stomach and quiets it after- 
ward. If the child vomits with great difficulty it is well to give 
a cathartic instead, such as a one-tenth grain calomel triturate 
every hour until ten have been taken, or one teaspoonful of Epsom 
salts in a half cup of warm, sweetened water, flavored with pepper- 



VOMITING. 

Vomiting is of such frequent occurrence with children as to 
deserve a few words. It may be discussed under two forms: (i) 
Harmless, and (2) Dangerous. Harmless vomiting is that which 
occurs in healthy babies soon after eating, where they throw up 
only a little food, and that not very often. Dangerous vomiting 
is that form which makes the child ill, and occurs at any time 
after feeding, the child throwing up all its food and continuing to 
do so for some time. 

The first form is so well recognized as harmless that there is 
a saying that "a baby that throws up after nursing is a healthy 
one." It is very easy for a baby to vomit and, if the stomach 
is overloaded, that usually makes it vomit, so when it gets too 
much milk and throws part of it up, the baby is more apt to be 
healthy than if the stomach retained it and could not digest it; 
but if a child digests its food it is better for it not to vomit. It 



DISEASES OF CHILDREN. 457 

is also better to give the child only such a quantity as it can digest, 
than to give it too much and let it vomit the excess. 

If the baby vomits persistently, loses flesh and appears sick, 
it is in a dangerous condition, and must be treated. At such a 
time the flesh usually becomes flabby, the skin has a scurfy appear- 
ance, often the stomach is distended, the face is "'pinched," and, 
unless the process can be arrested, the child eventually starves 
to death. 

Treatment. — The treatment is very largely one of feeding, 
although medicinal remedies are often helpful in arresting vomit- 
ing, and, at times, digestants are temporarily useful. To stop 
the vomiting and to help digest the food, Ingluvin has proven 
valuable ; one grain for a baby one year old, repeated every one to 
three hours. Very small doses of calomel are helpful ; one- 
twentieth of a grain every half hour for six or eight doses, then 
once every four hours, will relieve. Equal parts of lime water 
and cinnamonwater have many advocates. To a child two years old 
it should be given in teaspoonful doses. Small doses of Fowler's 
solution of arsenic not only control the vomiting, but are a good 
tonic, as well ; one drop doses repeated every four hours for a 
child one year old. 

In regard to foods at this time, see the article on Infant 
Feeding. 

Vomiting may be a symptom of a coming disease : 

i. When the pulse is quick, the stomach full, accompanied, 
perhaps, by either diarrhea or constipation, it indicates indigestion. 

2. If the vomiting comes on suddenly, and is followed in 
an hour or so by fever, and the throat is red and sore, scarlet 
fever is indicated. 

3. If the vomiting is free without much straining or effort, 
and the pulse is very slow, and at times irregular, and the abdo- 
men is retracted, and there is constipation, it is an indication of 
brain disease. 

4. Vomiting attended by severe pain and retching, followed 
by a collapsed condition, is an indication of intussusception, which 
means that a portion of the intestine has slipped into another por- 
tion of itself, stopping it up, just as part of a glove finger can be 
slipped into another part. 



458 DISEASES OF CHILDREN. 

EVACUATIONS FROM THE BOWELS. 

Before taking up the intestinal diseases, we desire to say a 
few things as to the passages being indicative of certain diseases 
and conditions. A healthy baby, less than a year old, nursing or 
being fed upon milk only, should have from one to four evacu- 
ations in twenty-four hours, usually about four for the first two 
months; three for the next two months; two per day between 
the ages of four and ten months; and after that one per day. 
There are many exceptions to this rule, even in healthy children, 
but every infant should have at least one evacuation each day. 

The feces of a healthy infant vary in color from a pale yellow 
to an orange yellow; they are smooth and about the consistency 
of cream ; sometimes being quite fluid, while at other times are 
almost stiff enough to keep form. Any decided variation 
from this, either in color or consistency, is an indication of some 
diseased condition. 

When little white lumps (curdled milk) appear, scattered 
through the feces, and the latter are somewhat formed and are 
lumpy and of a yellowish or brownish color, they indicate an ap- 
proaching attack of indigestion. 

In catarrhal inflammation of the bowels the movements be- 
come frequent, and the feces have a green color, are partly wa- 
tery, and partly formed and lumpy. Mucus resembling the white 
of an &gg is mixed through the feces, a result of the inflammation 
in the mucous membrane. 

It has long been a subject of investigation and discussion 
as to the cause of this green color. Some believe it is caused by 
the bile, some, that it is of bacterial origin, and others, that it is 
a chemical change and of no pathological importance. The fact 
that, sometimes, the color does not show much until after the 
passage points toward a chemical origin, but, whatever the cause, 
the green is indicative of catarrhal inflammation. 

If the discharges are very watery and contain much mucus, 
they indicate that a large surface is affected. The green color 
and slimy appearance are supposed by many to indicate a cold. 
This has arisen from the fact that a cold will often produce the 
disease, but, as other causes will also do this, it is better to re- 
gard the trouble as catarrhal inflammation. 

When blood appears in the stools, it indicates that the inflam- 
mation has destroyed the mucous membrane and opened one or 
more small blood vessels. 



DISEASES OF CHILDREN. 459 

There are several medicines, often given to babies, which 
change the color of the stools so decidedly as to alarm the mother, 
unless she knows the cause. The two remedies most likely to do 
this are iron and bismuth. They cause black, or greenish black 
stools which, as a rule, can easily be distinguished from the green 
of catarrhal inflammation. 

Blood appears more frequently in the feces of infants than in 
those of adults, but is not as dangerous, usually, as one would nat- 
urally expect. It may appear as a bright red, which anyone 
would at once recognize as blood, or it may be black and in little 
lumps, not appearing to be blood unless closely examined ; and 
it may even require a microscope to decide that it is blood. If 
the blood is of a bright red, and covers or streaks the feces, rather 
than mixing intimately with them, it indicates that there is a 
diseased condition near the anus, in the rectum, or lower end of 
the large intestine. If the blood is black and has a coffee-grounds 
appearance, the disease is probably in the small intestine, or even 
in the stomach. A physician should be consulted if the blood per- 
sists, but if it appears only once or twice no treatment is necessary. 

At times the feces have a very foul odor, as of decaying mat- 
ter. This is produced by the contents of the intestines fermenting 
or decaying, and poisonous compounds are often thus produced 
that cause very serious diarrheal troubles, including' cholera in- 
fantum. One of the best ways of treating this condition is to give 
a one-tenth of a grain calomel triturate every half hour until from 
eight to twelve have been taken, then give sufficient salts 
(Epsom, Glauber's or Rochelle) to produce a free movement 
of the bowels, thus washing out the decaying matter. The baby 
should be given no food at all for from twelve to twenty-four 
hours. 

COLIC. 

Colic is so frequent with children, less than three months of 
age, that a separate description seems desirable. It is a painful 
disease of early infancy, the pain being produced by gas collecting 
in the intestines or stomach. It is usually caused by -foods difficult 
of digestion, and is often attended by fermentative changes in the 
food. As a rule, the attack comes on soon after the baby has taken 
its food, but it may come at any time and may last from a few min- 
utes to hours. The child frets, groans and twists for a little while, 
then opens its mouth and yells, as if in the greatest agony. The 



460 - DISEASES OF CHILDREN. 

abdomen is distended and firm ; the hands clinched ; the legs drawn 
up and the whole body very rigid ; not continuously so, however, 
for at times the baby kicks and squirms. Often the attack termi- 
nates by the belching up of a little gas from the stomach or the 
escape of wind from the bowels, after which the baby seems per- 
fectly well and smiles and coos as if nothing at all had happened. 
So often is this the case that parents are led to believe that the 
baby is only cross and ugly, and cries merely to secure attention 
and be held or carried. Children undoubtedly do this sometimes, 
but their cries are then different — more coaxing and less continu- 
ous, and not attended with such a rigid condition of the body. 

Treatment.' — The treatment of colic is by no means an easy 
or simple matter, although everybody has something to recom- 
mend as a sure cure. Of course, the first indication for treatment 
is the pain, but we must remember that relieving the pain is not 
curing the colic, for it will surely return unless the cause is re- 
moved. This most frequently is indigestion. The proper treat- 
ment, therefore, will not stop when the pain is relieved. We 
should find just what form of indigestion is troubling the child 
and treat it accordingly. See article on Infant Feeding. 

If a food is given which agrees with the baby, the colic usually 
disappears. At times some digestive preparation is useful, such 
as peptonzyme, elixir lactopeptin, etc. The thing the parents 
most want and the baby first needs, however, is something to stop 
the pain. A multitude of drugs have been used for this purpose, 
but not one of them is uniformly successful. A remedy that acts 
like a charm at one time, at another fails entirely, or works beauti- 
fully with one child and not at all with another. It is necessary, 
therefore, to try different remedies. The carminatives or pain 
soothing medicines are the ones generally used. If peppermint 
or catnip can be obtained, it should be tried first. Make a tea 
of the green leaves, sweeten with a little sugar, and give it warm 
in teaspoonful doses every twenty minutes until the child is re- 
lieved. The oils of anise, cinnamon, cloves, peppermint, fennel 
and valerian are all useful. They should be greatly diluted, 
sweetened and given in the same way as the tea above mentioned. 

Asafetida, chloroform, whisky and opium, in some form, are 
sometimes used, but all except the first are such dangerous poi- 
sons they should not be given to a baby unless ordered by a 



DISEASES OF CHILDREN. 461 

physician. In severe cases either of the following prescriptions 
may be used : 

Sweet spirits of ether one dram 

Sulphate of magnesia one dram 

Oil of cajuput one drop 

Syrup of tolu one-half ounce 

Liquor carbonate of magnesia enough to make two ounces. 

Dose, one-half teaspoonful two to four times a day. 

Deodorized tincture of opium twenty drops 

Oil of anise, cloves and wintergreen . . . three drops each 

Tincture of asafetida one dram 

Carbonate of magnesia one dram 

Peppermint water enough to make four ounces. 

Dose, ten to twenty drops, repeated in half an hour, if nec- 
essary, 

CONSTIPATION. 

This is a very prevalent ailment among people of all ages, 
but less common in infants than in adults, yet it is very prevalent 
among babies that are brought up on artificial food. Much can 
be done to correct the condition in adults by using suitable foods, 
but with the baby our bill of fare is limited, and other means must 
be employed. Constipation may exist, even though the bowels 
move once each day, and it often alternates with diarrhea. We 
may define constipation as that condition of the bowels which 
causes infrequent, irregular or abnormally hard stools. Of course, 
if the bowels are loose we call the condition diarrhea, but if the 
usual condition is a hard, infrequent stool, it may be that the con- 
stipation has caused the diarrhea, in which case it is constipation, 
not diarrhea, that needs treatment. 

Constipation may be caused by malformation of the rectum 
or anus, and whenever it exists from birth these parts of the body 
should be examined by a competent physician. The anus may 
be too tight and have to be stretched — a condition producing 
severe pain whenever the bowels move, even though the feces be 
comparativly soft. Pain is also produced when there is a fissure 
or tear of the anus. 

In treating a baby for constipation, we should have a large 
knowledge of means, as no one treatment is always effective. We 
therefore mention a number of plans, one or more of which may 



462 DISEASES OF CHILDREN. 

be tried at one time. Rubbing the bowels in a circular direction 
from right to left, with or without some oily preparation, is some- 
times effective. If the baby is thin, pure cod-liver oil is best, 
but if it is plump and healthy, lard, sweet oil or cocoa butter are 
suitable. A soap pencil, from two to three inches long and from 
one-fourth to one-third of an inch thick, dipped in warm water 
or glycerin and inserted into the rectum and held there until the 
child begins to strain, is often effective. Wyeth Brothers of 
Philadelphia put up glycerin suppositories, similar in shape to the 
soap pencil and used in the same way, that are often better. An- 
other plan is to mix one part of glycerin and three parts of water 
and inject from two to four teaspoonfuls into the rectum; done 
most conveniently by using a small rubber syringe that will hold 
just the required amount. Warm water or soapy water injections 
are sometimes employed, but we doubt their value for everyday 
use, our observation being that they create necessity for their con- 
tinuance instead of aiding in the cure of the constipation. Their 
occasional use, however, is proper. These means of securing 
passages are harmless and should be tried before resorting to 
medicines, and sometimes continued while medicine is being used. 

In the way of drugs we have obtained the best results from 
either cascara aromatic, fifteen drops ; sodium phosphate, three to 
five grains ; syrup of senna, half a teaspoonful, or a pill, composed 
of aloin, belladonna and strychnia, on sale at the drugstores. The 
above doses are for a baby one year old, and any one of them 
should be given at bedtime. 

After the baby is a year old we may aid in the correction 
of this difficulty by giving it certain foods. Oatmeal water, made 
by boiling a heaping tablespoonful of oat flakes or meal in a 
quart of water for two or more hours, adding water from time to 
time that there may be a quart at the end, should be strained and 
added to the baby's milk, equal parts of each. Scraped apples 
are useful ; so is grape juice, or prune juice, or other fruit juices. 
The pulp and seeds should not be used. 

INTESTINAL DISEASES. 

In medical works these diseases are described under a good 
many different names. To attempt an exhaustive description of 
them here would be to confuse rather than to help. I shall there- 



DISEASES OF CHILDREN. 463 

fore simplify by putting what I have to say under three heads : (i) 
Diarrheas. (2) Catarrhal inflammation of the intestines. (3) 
Cholera infantum. 

DIARRHEA. 

Diarrhea may be defined as being too frequent and too liquid 
discharges from the bowels. This condition may exist in a child 
for some time without producing any serious symptoms ; indeed, 
I have seen infants who have not been free from it Ave days in 
succession for three or four months, yet have not been in bed a 
single day because of it. These, however, are exceptional cases. 
The rule is that whenever the discharges grow thin, watery and 
frequent, the child becomes weak, emaciated and sick. 

There is a distinct tendency toward a chronic condition in 
this disease, and it is very likely to take on severer forms unless 
promptly checked. With this form there is little or no fever, very 
little pain, and not very much weakness, the diarrhea being the 
most prominent symptom. The causes are hot weather, filth, 
putrefaction, sudden barometric changes, overfeeding, improper 
feeding, teething and overexertion or excitement. 

Treatment. — The treatment is usually simple and quickly ef- 
fective if used early in the attack. There are two things to do. 
First: Empty the bowels of all irritating material. Second: Give 
some antiseptic and soothing medicine, which will stop fermenta- 
tion and allay irritation. 

Perhaps the best and quickest way to accomplish the former 
object is to give an even teaspoonful of Epsom or Glauber's salts 
in one-third of a glass of sweetened water, to a baby from one to 
two years old, and repeat every hour until the bowels move freely. 
If the child objects too vigorously to the salts, give, instead, a 
one-tenth grain calomel triturate every half-hour until a free move- 
ment is secured. Castor oil, rhubarb or senna may be used if 
preferred. During the administration of the cathartic, and for 
several hours after its action, it is advisable to give no food at all, 
but the child should be allowed all the cool water it wishes, unless 
it causes vomiting:. 

For the second part of the treatment bismuth, either the sub- 
carbonate or subnitrate, stands at the head of the list, as a mild, 
soothing antiseptic for the bowels, and is usually sufficient. Sul- 
phocarbolate of zinc or of soda are more recent drugs, and are 



464 - DISEASES OF CHILDREN. 

efficient, and euthymol, Hsterine or other similar preparations 
are sometimes useful. For a week after an attack of diarrhea the 
diet of the child should be carefully regulated as to time of feed- 
ing and quantity and kinds of food. Sterilized milk is one of 
the best foods. Stale or toasted bread may be given babies over 
a year and a half old. Barley water and milk, white of eggs in 
water, beef juice, custard and blanche mange are all appropriate 
foods. Avoid fruits, vegetables, and too much sweet or starchy 
food. 

CATARRHAL INFLAMMATION OF THE INTESTINES. 

Under this name we will describe those inflammatory condi- 
tions of the intestines which occur so frequently during hot 
weather, in infants from one to three years of age, and which are 
called by many different names, as Summer Complaint, Gastro- 
intestinal Infection, Entero-collitis, etc. 

This disease occurs most frequently in the most thickly in- 
habited portions of large cities, and amid filthy surroundings. 
It is most apt to attack children during their second summer, 
but may come at any time until the child has reached three or 
four years. 

The mucous lining of the intestines is the part involved, and 
the fact that it may be in any part of the intestinal tract and of 
any degree of intensity, and is produced by a variety of causes, 
have led to the varied classification. Sometimes it is severe 
enough to produce death, yet a postmortem examination may 
show very slight inflammation. At other times the inflamma- 
tion may be so intense as to eat clear through the intestines. At 
• first the inflammation causes the cells of the mucous membrane 
to become swollen, then softened, then destroyed, so that pieces 
of the membrane sometimes slough off and are found in the stools. 
These pieces may be in shreds, and be mistaken for worms, or 
the whole inside coat of a portion of the intestine may come away 
and look just as if a section of the entire intestine had come. 
Sometimes the symptoms are very severe, with much fever, brain 
disturbance and prostration, at other times the child does not 
have to go to bed; but, whatever the cause, and however much 
the manifestations may vary in intensity, the disease is an in- 
flamed condition of the intestine. 

Perhaps the most striking cause is hot weather, high av- 



DISEASES OF CHILDREN. 465 

erage heat for twenty-four hours. A high temperature for a few 
hours, or a hot day followed by a cool night, does not seem to 
be as bad as continuous heat. It has been shown by statistics 
that by far the greatest average mortality from this disease occurs 
during the second and third weeks of July, and always during the 
period of greatest heat. It has often- been regarded as a germ 
disease, but, while many kinds of bacilli are found in the feces, 
no one variety has been shown to be always present or to produce 
the same disease in animals. That the disease chiefly occurs 
under conditions most favorable to the growth of germs, and, in 
certain forms, is quite similar in its course to other germ dis- 
eases, points strongly to a germ origin, but as yet we cannot 
demonstrate it. 

A second cause is found in the age of the child, it being 
most common at two years or a little less ; probably because the 
membranes at this age are very tender and easily disturbed, and 
because digestion is not yet thoroughly established. 

A third cause is improper feeding. Most children having this 
disease are bottle-fed babies, and very frequently some improper 
food can be shown to have caused the attack. During hot 
weather only a little food is needed, and that should be of a kind 
that is easily and quickly digested. The article on Infant Feed- 
ing shows the proper kinds of food and how they should be given. 
Diarrhea and previous indigestion very often lead to this severer 
disease, for which reason no case of diarrhea or indigestion should 
be neglected. At times the passages, by their odor and by being 
full of little bubbles, show plainly that there is fermentation going 
on — a frequent cause of the disease. Bacteria are particularly 
numerous in these cases, and doubtless play an important part in 
their causation. 

Although the symptoms of the disease vary considerably in 
intensity and kind, diarrhea is always present, and usually there 
is vomiting, fever and pain. A somewhat typical case is seen in 
a usually healthy baby that becomes cross and restless; it does 
not sleep as well as usual, wakes suddenly in the middle of its 
day nap and begins to cry and twist ; refuses food, or perhaps takes 
some food and in a few minutes throws it up. This is usually 
sour. We next notice that there is fever and the pulse is very 
fast ; the palms of the hands and soles of the feet are hot and dry. 
In a time, varying from a few hours to twenty-four, the bowels 

30 



466 ' DISEASES OF CHILDREN. 

move, and the passages are watery and smell either sour or foul. 
The abdomen is swollen and tense, and when tapped upon sounds 
drum-like, thus indicating that the intestines are full of gas. 
Usually, too, there is much rumbling. 

If the case grows worse, the passages become quite frequent 
(six to twenty in a day) and small in quantity; the child quickly 
becomes emaciated; the eyes, sunken; the muscles, flabby. If 
death results, the end usually comes in one of two ways: 

First. The child becomes drowsy, seems exhausted, is hard 
to rouse; the hands and feet grow cold; the nose is cold; the 
breathing becomes slow, with a quick inspiration and a slow ex- 
piration, and the child passes away quietly. 

Second. The child becomes very fretful, vomits often, cries 
out with a piercing scream; the skin becomes very hot and dry; 
the head rolls from side to side ; the eyes become crossed ; convul- 
sions come, and death relieves the little sufferer. 

While most of the babies thus attacked recover, many die, 
hence this should always be regarded as a serious disease, and 
the child should be attended to at once, even though at first it 
does not seem very ill. The younger the baby, the more sudden 
the attack, the higher the fever, and the more numerous the 
symptoms of the graver disease. Relapses are very apt to occur, 
and where a baby is attacked early in the summer it will require 
careful attention until fall, although it may not be sick all the 
time. 

The disease may prove fatal in a few days, or it may continue 
for months, and even then end in recovery. No case should be 
given up to die. We must work as long as life lasts, for a child 
sometimes recovers when it seems as if it must die. 

Treatment. — Before describing the medical treatment, it is 
desirable to speak of the general care of the baby, for its recovery 
depends upon that quite as much as upon the medicine it gets. 
If the mother is a competent nurse she should devote herself to 
the child and have as little other care as possible. If she is not a 
skillful nurse (many most excellent mothers are not) she should 
eet someone who is able to care for it. A trained nurse is the best 
help, but if one cannot be obtained, an efficient woman can usually 
be found. 

Remembering that heat is a cause of the disease, we should 
do all we can to keep the little sufferer cool. When it can be 



DISEASES OF CHILDREN. 467 

afforded, the baby should be taken to the seashore or mountains ; 
but, unfortunately, this cannot often be done, and many times 
we have to do the best we can with very limited means. Some- 
times it can be taken into the country for a few days. In some 
cities the public park offers a place that is cooler than the home. 
If no such resort is accessible, the coolest room in the home should 
be selected and made as comfortable as possible. Wet towels, 
hung in front of the windows where the draught will cause rapid 
evaporation, will help. Sometimes a large shade tree in the 
yard offers a cool place, and at times the gentle swing of a ham- 
mock is a real comfort. In many homes electric fans can be used 
to advantage. We can mention here only a few ways, but hope 
that these may lead parents and friends to devise others. 

When there is fever, the bath is often the best means of 
relief. The baby can be put in a tub of warm (99 degrees) water, 
then cool water be added until the temperature is about 75 de- 
grees or 80 degrees. If the child does not enjoy this, it can be 
sponged with cool (85 degrees to 90 degrees) water, or a cloth 
wrung out of cold (60 degrees) water can be placed over the 
forehead and crown of the head, and frequently changed. The 
clothing should be very light and simple. A flannel or silk band, 
a dress of thin flannel or woolen goods, and diapers of some soft 
material, are usually enough. 

The baby generally craves cold water, and should get it often. 
Let the water be boiled for thirty minutes and aerated, and one 
or two tablespoonfuls given at a time. The water replaces that 
drained from the tissues by the diarrhea, and helps to control the 
fever. Sometimes the stomach is so irritable that even water 
cannot be retained; in which case the white of an tgg may be 
mixed with a pint of boiled water, and a teaspoonful given every 
five or ten minutes. If this is not retained, wait from one to four 
hours, then try again. If it still vomits, an injection of salt water, 
a teaspoonful to the quart, should be used, and the buttocks held 
together to retain it as long as possible. 

The food of the baby is very important, and the article on 
Infant Feeding should be consulted. If the milk comes through 
curdled and foul-smelling, and the baby is cross and feverish., the 
milk should be withheld from twenty-four to forty-eight hours, 
and beet juice, Bovenine, white of eggs or Panopepton given 
in its place. If they do not agree grape juice or blackberry juice 



46S DISEASES OF CHILDREN. 

may be tried. At times it is well to give nothing; the tendency 
in hot weather is to overfeed. The baby often cries as if hun- 
gry, when only thirsty. When we return to the milk, we should 
give it in a diluted form and very gradually restore the normal 
amount of food. 

Medical treatment has four things to do: (i) Clear the 
bowels of irritating matter. (2) Stop decomposition. (3) Re- 
store the normal action of the bow r els. (4) Heal the inflamed 
mucous membrane. 

(1.) A brisk, quick cathartic is the best means of washing 
out the bowels. Epsom, Glauber's or Rochelle salts are ex- 
cellent, because of their speedy action and the watery passages 
they produce. They are particularly indicated early in the attack. 
If the diarrhea has 'lasted a day or more, one-tenth grain calomel 
triturates are better, and should be given every half-hour until 
six or eight are taken by a child one year old. If they do not pro- 
duce free action of the bowels, salts should be given after the 
calomel has been taken. Castor oil is efficient ; aromatic syrup of 
rhubarb is also good. 

(2.) We stop decomposition by the means of antiseptic medi- 
cines. There have been so many kinds tried that we will not 
attempt to name them, but will mention a few that have been well 
proven: Subnitrate of bismuth stands at the head, and should 
be given in one to five grain doses to a child one year old. Sul- 
phocarbolate of zinc or of sodium is now largely used, either 
alone or combined. I use the sodium when there is much fer- 
mentation, but the zinc when the passages incline to be serous 
in character. The dose for a year-old baby is one-half to one 
grain of the zinc salt, or one to three grains of the sodium. Ar- 
senite of copper in very small doses (one five-hundredth of a 
grain) is quite useful where the nervous symptoms prevail. Boro- 
lyptol, listerine and euthymol are useful ; subgallate of bismuth, 
salol and resorcin are also employed. 

(3.) Diarrheal diseases weaken a child very rapidly, and are 
likely to leave the digestive organs in a weakened condition, hence 
the food should be very carefully regulated for at least a week 
after an attack, and it is usually desirable to give a tonic and 
digestive preparation for a while to restore the normal condition. 
As a tonic, some preparation of iron, strychnia or arsenic is de- 
sirable, either in combination or separately. Hypophosphites are 



DISEASES OF CHILDREN. 469 

good ; arsenite of iron or strychnia is also useful. Pepsin and pan- 
creatin, in any of the many good preparations, are to be used 
when the food is not digested. Peptonzyme is largely used, also 
lactopeptine. 

(4.) When the disease has been severe or long continued, 
ulcers or patches denuded of mucous membrane are sometimes 
produced and require attention. A "whitewash" composed of 
thin starch water and bismuth subnitrate, is very useful, employed 
as an injection. Of course, injections can reach only places in 
the large intestine ; for those in the small intestine medicines 
through the mouth must be used, subnitrate of bismuth being one 
cf the best. The buttocks of the baby sometimes become in- 
flamed from irritating discharges, for which oxide of zinc oint- 
ment, benzoated, is one of the best applications, except in a few 
cases, when a dry preparation is better. Powdered boric acid 
or bismuth subgallate are excellent, either alone or mixed with 
an equal quantity of corn starch or powdered talc. 

CHOLERA INFANTUM. 

Cholera infantum is one of the most fatal, and, therefore, one 
of the most dreaded of children's diseases. It comes during the 
hot months of summer, particularly when the mean temperature 
for the twenty-four hours is above 70 degrees, and is caused 
by a poison which is developed in milk, and probably is the 
ptomain, tyrotoxicon, discovered by Dr. Vaughn of Ann Arbor. 
His experiments show that it is especially likely to appear in milk 
that is put into cans while warm, then closed and allowed to 
stand in a warm place. It has been found in cheese, as well as in 
milk, though infrequently. When this tyrotoxicon is given to 
animals they have symptoms very much like the child that has 
cholera infantum. 

Symptoms. — Attacks of cholera infantum always come sud- 
denly and with great severity, even when preceded by a diarrheal 
difficulty. A healthy child, suddenly and without any warning, 
may come down with cholera infantum, or in an unhealthy one, 
who has but recently recovered from a diarrhea, or is still suffering 
with it, an attack of cholera infantum may suddenly develop, either 
in addition to, or taking the place of the other disease. Purging 
suddenly begins, and the feces become watery and cf a musty 
odor, and although at times at the beginning of the attack the odor 
may be very foul, its characteristic smell is musty. 



470 DISEASES OF C HIED REN. 

Along with the purging comes severe vomiting, the vomiting 
usually accompanying each movement of the bowels. The stools 
at first are copious, but as the disease progresses and the child 
grows weaker they become less in quantity. The frequency of 
the bowel movements is so great as to be very indicative of the 
disease ; they sometimes reach as many as thirty or forty in twenty- 
four hours, and for a while may occur every few minutes. The 
vomiting is severe and nausea is almost continuous. If at the be- 
ginning of the attack there is food or mucus in the stomach it is 
first vomited, then a serous watery material is thrown out, after 
which there may be retching and vigorous attempts at vomiting 
without results. Food and water only increase the vomiting and 
nausea, and although thirst is intense ail through the disease we 
cannot give the baby drink because that increases the vomiting. 

So much serous matter is vomited and thrown of! by the 
bowels as to produce great prostration, and emaciation progresses 
at a fearful rate. A baby, fat and healthy one day, may become 
so emaciated the next that its skin becomes wrinkled and its 
muscles flabby. The most frequent cause of death is exhaustion, 
due to this terrible waste. At first the child is irritable and throws 
itself about, but gradually goes into a comatose condition from 
which it rarely recovers. 

The nervous symptoms are usually marked and convulsions 
are not infrequent. The eyes become sunken and have the vacant 
stare so characteristic of brain disease. Often the baby rolls its 
mead from side to side with a jerky, uncertain movement, and in- 
terrupts its fretful, peevish cry with a piercing scream. 

The temperature is almost always high, ranging from 103 
degrees to 107 degrees per rectum, but at the same time the face, 
hands and feet, and sometimes even the body, may feel cool. This 
means that the surface temperature may be sub-normal (below 
98.6 degrees), while the rectal temperature is 103 degrees or more. 

Such are the symptoms of this dread disease, and while they 
may not all exist in a typical form in every case, there are usually 
enough of them to make the diagnosis easy and positive. 

Treatment. — First and best of all is preventive treatment. It 
may be set down as a fact that the baby will not have cholera in- 
fantum unless it be given infected milk. Some physicians believe 
that it has been taken from milk left on the mother's nipple after 
nursing, which, having become infected, evaporates, leaving its 



DISEASES OF CHILDREN. 471 

infectious poison to be taken into the mouth of the child at the 
next nursing. It. is also believed that a child, by sucking its own 
fingers, may get this poison, developed by milk, with which they 
have been wet, becoming infected. Such a thing is certainly pos- 
sible, but, in our opinion, exceedingly rare. 

The most frequent source of infection is found in milk im- 
properly cared for in some stage of its transition from the cow to 
the baby, hence, the importance of intelligent preventive treat- 
ment. Milk, as it comes from the cow, is practically sterile, and 
if we can keep it so until the baby gets it there will be no cholera 
infantum, and very much less summer complaint. 

The important factors in keeping milk sterile are these: (i) 
Make the time from cow to baby as short as possible. (2) Cool 
the milk quickly and keep it cool, unless it can be fed immediately 
after the milking. (3) Thoroughly boil all vessels used for the 
milk. (4) Keep the milk in a clean place, as well while at the stable 
as while in the ice chest. (5) Sterilize the milk in all cases of 
doubt, by keeping it for thirty minutes at about 165 degrees 
Fahrenheit. 

Treatment of the Attack. — The first thing is to get rid of the 
poison. As it comes from milk, we should give the child no milk 
during the attack, and in some cases it should be withheld for a 
month afterward. Beef juice, albumen water and broths are the 
best substitutes. If the disease is detected early in the attack, an 
active cathartic should be given, consisting of six or eight one- 
tenth of a grain calomel triturates given a half hour apart to a 
child a year old, or a teaspoonful of castor oil, either of which is 
to be followed two hours later by a teaspoonful of Epsom or 
Glauber's salts, the latter being preferable. 

If the bowels have been moving very frequently and the de- 
jections had the musty smell and serous character, the cathartic 
should not be given, but the bowels should be washed out with 
an antiseptic injection, such as two teaspoonfuls of borolyptol or 
euthymol or bismuth in a pint of sterilized water, and this should 
be clone every two to four hours. 

For the exhaustion stimulants are necessary and small doses 
of brandy, repeated every thirty minutes to an hour, are recom- 
mended by many authors, but my temperance convictions lead 
me to substitute in its stead, strychnia — one two-hundredth of a 
grain of strychnia sulphate, given a baby one year old, every half 



472 - DISEASES OF CHILDREN. 

hour, being of greatest value. The hot pack or bath, with or with- 
out mustard, is helpful in bringing the blood to the surface and 
thereby lessening the internal congestion. Digitalis is also used, 
and at times a hypodermic injection of morphia and atropia is 
useful in controlling the vomiting, and copper arsenates and car- 
bolic acid are used sometimes with benefit, but the frequent irriga- 
tion of the rectum with some antiseptic wash, as recommended 
above, is perhaps the best treatment. The child needs careful 
watching as to food and exercise for weeks after the acute attack, 
and milk should not again be given it until it has regained its 
strength, or at least until its digestion has become good. 



CHAPTER IV. 

SCARLET FEVER. 

Scarlet fever is a germ disease and a very contagious one. 
Not only will the patient give it from the time of its first appear- 
ance until the scaling period is past and he has been washed in a 
disinfectant, but all articles handled by him, such as furniture, 
books and toys, are likely to become mediums of contagion. It 
has often been carried by letters hundreds of miles. Infected 
clothing is a frequent means of spreading the disease and retains 
the virus a very long time. Hildebrand contracted scarlet fever 
from a cloak that had been put away after exposure, eighteen 
months before, and a case is reported in which the source of con- 
tagion was traced to an infected picture book that had been packed 
away in a trunk for twenty-six years. 

It may be taken at any time, but is most frequent in children 
from eighteen months to six years of age. The older a person 
grows the less likely is he to contract this disease, or to suffer 
seriously in case he does take it. Children with fresh wounds and 
women just after delivery are especially liable to scarlet fever. 
When patients have fully recovered the cases of recurrence are 
rare. 

The onset is sudden and occurs from two to eight days after 
exposure. 

The first symptoms are chilliness, fever, sore throat, lassitude, 
headache, coated tongue, nausea, vomiting, delirium and in small 
children sometimes convulsions. Sore throat is usually, if not 
always, present and often is the first symptom noticed in adults. 
The rash appears the second day and consists of bright scarlet red 
dots or points, in countless numbers, at first separate and distinct, 
but soon running together and covering the entire surface, except 
the nose and lips, which, from contrast with the rest of the face, 
present a strangely pallid appearance. It is first seen upon the 
sides of the neck, then upon the chest and abdomen and later upon 
the extremities and face, attains its maximum in two or three days 

473 



474 ' DISEASES OF CHILDREN. 

and remains stationary from twenty-four to thirty-six hours, then 
gradually subsides. The color disappears under slight pressure. 
When the finger-nail is drawn over the surface a white streak 
appears, which soon resumes the same hue as before. 

There is usually very high fever, the temperature often reach- 
ing J 05 degrees the first day, going a little higher the next, then 
remaining high every day until the eruption fades away, when 
the fever also begins to subside. The scaling or peeling begins 
from three to five days later and generally continues from four to 
five weeks, not often less than two or more than eight weeks, dur- 
ing which period the fever all disappears and the tonsils resume 
their normal size. 

Sore throat is at times the most serious feature of the disease 
and should always receive careful attention. The mucous mem- 
brane of the soft palate, uvula and pillars of the fauces are red- 
dened and swollen, the redness often extending forward over the 
inner surface of the mouth. The tonsils may also be swollen and 
their follicles distended by a reddish white exudate, which some- 
times passes over the surface, forming a false membrane. In 
moderately severe cases there may be ulceration and even slight 
gangrene, while in others an abscess may form in the tonsil itself. 

Measles may be distinguished from scarlet fever by the milder 
character of the symptoms in the former disease and the longer 
time between the exposure and their first appearance. In measles 
there are more catarrhal symptoms and likely to be more cough, 
but not as high temperature, and the rash is papular in character, 
while that of scarlet fever is punctate. The membrane which ap- 
pears on the throat in scarlet fever is distinct in character from 
that of other diseases, and less amenable to treatment than that of 
diphtheria, which may either accompany or follow scarlet fever, 
for not one of the contagious diseases is any protection against 
the others or renders the patient at all immune, but rather in- 
creases his liability to contract them if exposed either during his 
illness or while convalescent. 

Treatment. — The patient should be kept in a large, well ven- 
tilated room, with a south exposure, in the upper story of the 
house. One of the windows should be constantly open at the top 
and bottom, and if the weather permits an open fire should be 
kept burning. The temperature should remain as near 70 degrees 
as possible and the room should be very clean. From it should be 




iinMriiiTmn'Tii 




DISEASES OF CHILDREN. 475 

moved all carpets, curtains, upholstered furniture and porous 
materials, and a sheet saturated in a disinfectant should he hung 
over the outside of the door. Only those really needed to care 
for the patient should enter it. The bed linen should be changed 
often, and cleanliness, both of person and surroundings, carefully 
maintained. All the sputa and dejections should be immediately 
and thoroughly disinfected. (See Department on Disinfectants.) 

The first thing to be done, when the patient is taken ill, is to 
give him a bath at about 88 degrees, lasting fifteen or twenty 
minutes, during which soap should be freely used over the entire 
body, and the skin well cleaned. If there is high fever, sponge the 
body with tepid water every ten or fifteen minutes, continuing 
until the temperature is reduced from one to two degrees ; or give 
from one to two and a half grains of phenacetin every four hours to 
secure reduction of temperature and moisture of skin, and to 
quiet the patient. Tincture of aconite root, from one-sixth to 
one-half drop, may be used instead. If profuse sweating follows, 
reduce the dose or discontinue it. A warm bath should be given 
each day, after which anoint the skin with carbolized vaseline 
containing two per cent of tartaric acid. 

Where there are bad throat symptoms, spray the throat with 
peroxide of hydrogen and follow with the almond oil mixture, as 
per directions in the treatment of diphtheria. Hot water may 
be used as a gargle ; a listerine solution, one part of listerine to 
seven of water, may also be used in the same way, and a half tea- 
spoonful swallowed once an hour to disinfect the throat. 
Abscesses of the tonsil should be lanced. Indeed, this should be 
the prompt treatment of an abscess appearing anywhere during 
this disease, as delay often results very seriously. 

If catarrhal symptoms appear in the nose, a pint of warm 
water, containing as many boric acid crystals as the water will 
dissolve, while cool, should be run into one nostril and allowed to 
pass out through the other. In doing this use a fountain syringe 
and very mild pressure, elevating the bag only just enough to al- 
low the water to run through easily and thus avoiding the danger 
to the ears, which arises with much pressure, having first cautioned 
the patient against trying to swallow. 

Obstinate vomiting at the beginning indicates a grave form 
of the disease, and is best controlled by hydrate of chloral, five 
to ten grains in an ounce of water. If the stomach refuses to 



476 ' DISEASES OF CHILDREN. 

retain it, give the same amount by injection every three hours un- 
til the symptom is controlled. 

For convulsions give one grain of hydrate of chloral every 
hour. If there is scant urine, give from one to five grains of bro- 
mide of potassium every four hours to act upon the kidneys. 
Sponging with warm water is of great value in cases of continuous 
high fever. Warm water applied to the head is often excellent, 
both to relieve delirium and to induce sleep. 

The ears should be closely watched, and in case of a dis- 
order there, they should be washed out with water as warm as 
can be borne, after which, if there be any discharge, they should 
be filled with powdered boric acid. Should the discharge become 
chronic, it is best treated with dilute sulphuric acid and quinine. 
The same is true of chronic discharges from the nose. 

In case of very scant urine, the food should consist entirely 
of milk, but, if the stomach will not tolerate it, soft poached eggs 
may be eaten. This to guard against the development of Bright's 
disease. (See Nephritis.) 

Only in cases of exhaustion should stimulants be given. 
Strong coffee is one of the most highly recommended for such 
occasions, but brandy may be used instead. 

It should be more generally understood that scarletina and 
scarlet fever are one and the same thing, and that, however mild 
the attack, the patient is liable to all the sequelae of the disease 
and that the contagion he imparts may, in the next case, assume 
the most virulent form. 

The patient should remain in bed three weeks, and should 
stay in his room three more ; even then he will not have passed 
all danger from the ills that follow scarlet fever. He should ab- 
stain from meat and live chiefly upon milk for a month after re- 
covery, as a precaution against kidney disease, and not until he 
has had three or four warm baths in which carbolic soap, or some 
other good antiseptic soap, is freely used, and has been dressed 
in clothing free from infection, should he be permitted to resume 
his place with the rest of the family. All bedding and clothing 
that have been used about him should be boiled thirty minutes, 
and his room must be most thoroughly disinfected. 



DISEASES OE C El I ED REX. 477 

MEASLES. 

Measles is an acute, infectious disease characterized by a 
papular eruption. It is due to a germ, and mostly occurs in epi- 
demics. It may come on so slowly as to make it impossible to 
determine the first day of attack, but is likely to come suddenly. 

Symptoms. — Usually in nine or ten days after exposure, ca- 
tarrhal symptoms begin, a watery fluid runs from the nose, the 
eyes begin to water, the child rubs them and they become inflamed, 
red and sensitive to light. These symptoms gradually grow 
Avorse until about the third or fourth day, when small spots, vary- 
ing in size from a pinhead to a navy bean, begin to appear on 
the face, and in about twenty-four hours are scattered over the 
whole body. During the catarrhal symptoms there is very little 
if any fever, but as soon as the spots commence to show the 
temperature begins to rise, and continues to increase until the 
rash reaches its height; the fever then remains about the same 
for twenty-four to thirty-six hours, after which it gradually 
declines — lasting from three to six days. 

The eruption is generally of a brick-red color, sometimes 
bluish red, but never scarlet. It is first seen on the forehead and 
chin, then spreads over the face and the entire body, giving it 
a rough feeling to the hand, and reaches its height in about twenty- 
four hours. As this rash peels orY the other symptoms decline, 
excepting the cough, which is likely to continue harsh and dry 
until the rash disappears, and may last several weeks. Usually 
the time from the attack to full recovery is about two weeks. 
Measles alone is not a fatal disease, but it is liable to various ac- 
companiments, which may lead to very dangerous complications, 
the most serious of which are bronchitis and broncho-pneumonia. 

Treatment. — There is no way after exposure to prevent or 
abort measles. It will run its course. The treatment should be 
mild and guard against the appearance of other diseases. Great 
care should be used to prevent the patient from taking cold. He 
must be kept out of damp, cold air and all draughts. To a child 
five years old give two grains of muriate of ammonia every three 
hours, and, if the eruption is slow to appear, he may be put in 
a warm bath containing one tablespoonful of mustard to each 
two gallons of water. Let him drink freely of cold water, since 
it not only slakes thirst but reacts upon the skin. Warm drinks, 
such as sage and catnip tea, are also good to assist in bringing 
out the rash. 



478 ' DISEASES OF CHILDREN. 

Keep the bowels open by mild remedies, such as Castoria, 
or tea made from senna, or, for a child of five years, a teaspoonful 
of Glauber's or Epsom salts, every four hours until the bowels 
move freely. It should be remembered that in this disease the 
bowels are easily influenced and that care should therefore be 
taken in the use of medicines. In case of diarrhea give from 
three to five grains of subnitrate of bismuth every four hours. 

The eyes should not be used much, and if light irritates them 
the room should be darkened. 

If the symptoms are grave and indicate bronchitis or pneu- 
monia, give from one to three grains of carbonate of ammonia 
in a teaspoonful of syrup of tolu every two hours, or, if the 
case is less urgent, once in four hours. Moderately strong tea 
made from thoroughwort or boneset, well, sweetened and hot, 
taken in large draughts, then covering the patient warmly to 
induce perspiration, is excellent in this complication, but it is 
hard to get small children to drink it. 

Broncho-pneumonia begins as ordinary bronchitis and grows 
in severity; a snoring noise is made in breathing which increases 
in pitch and becomes a dry, ringing sound, as the disease advances; 
the fever is usually high and breathing difficult. Broncho-pneu- 
monia is also contagious in its early stages, hence the patient 
should be separated immediately from the rest of the family, even 
if the others have already had measles. As a preventive measure 
and to protect the patient from secondary infection, Dr. Comby 
of Paris recommends spraying, the mouth, throat and nose with 
a four per cent solution of boric acid once in six hours, and 
with the same kind of solution washing the genitals, anus and all 
parts of the body soiled by the dejections, every morning and 
evening. We will add that this is an excellent disinfectant, too, 
for measles, and that its use from the first is a wise precaution. 
The treatment includes anointing the pharynx and nostrils by 
inserting in them wads of absorbent cotton, covered with borated 
vaseline. This germ is short-lived and broncho-pneumonia is 
contagious during only the first two to four days after its appear- 
ance. Death from this malady may either occur soon or several 
months after recovery from measles. 

As already stated, measles runs its course in two weeks, but 
from bad hygiene, previously weak and run-down condition of 
the system, or from the presence of tuberculosis, syphilis or other 









DISEASES OF CHILDREN. 479 

specific taint, the recovery may be very much delayed and 
serious results ensue. 

Throughout this disease, milk, soups and soft eggs are the 
best diet. 

On the return to health precautions must be taken against 
catching cold, and warm flannels should be worn next the skin, 
for deafness, chronic bronchitis, enlargement of the tonsils and 
many other disorders are liable to follow even slight exposure 
at this time. 

BLACK MEASLES. 

This disease is only common measles in a very aggravated 
form. The malignancy is caused by previous poor health, or a 
depraved condition of the system. The blackish or purplish color 
assumed by the rash in this kind of measles is due to venous 
biood collecting in the capillaries near the surface of the skin, 
and shows that the blood is in an impure and sluggish condition. 

ROTHELN. 
(German Measles.) 

Rotheln is a specific, eruptive, highly infectious disease, in 
many points resembling both measles and scarlet fever, but with 
qualities quite apart from those diseases, besides differing from 
them in incubation, invasion and eruption. Its period of incu- 
bation varies from five to twenty-two days, and the time from 
the first symptoms to the height of the rash is from one to three 
days. The rash presents two principal forms, of which one resem- 
bles measles, the other, scarlet fever. In either form it is likely 
to leave one part of the body at the same time that it develops 
in some other part, and although it may disappear entirely in a 
day or two, it may remain four or five days. 

There is catarrh as in measles, but in measles the rash is longer 
in reaching its height. In measles there is not much sore throat, 
and no enlargement of the glands of the neck; but in rotheln 
enlargement of these glands is the most prominent symptom, and 
there is also soreness and stiffness felt in moving the head. The 
sore throat in rotheln resembles that of scarlet fever, but in 
scarlet fever the constitutional symptoms are more severe, the 
rash is more diffuse, and the tongue presents a peculiar straw- 
berry appearance. As in measles, the germ is short lived and 



480 ' DISEASES OF C HIED REN. 

when the patient recovers he is no longer a source of danger to 
his neighbors. Neither disease is any protection against the 
other. 

Treatment. — The same as for measles. 

VARICELLA. 
(Chicken-pox.) 

This was formerly supposed by many to be a modified form 
of small-pox, but it is now positively known to be a distinct dis- 
ease due to a specific germ, which, like small-pox, may be trans- 
mitted either with or without direct contact. It is a very mild 
disease, usually comes in epidemics, and never attacks one the 
second time. It is usually seen in children only, but now and 
then occurs in young or adult women. 

The eruption is likely to appear in from ten to four- 
teen days, but may appear as late as eighteen days 
after exposure, and usually is the first symptom, but, 
occasionally, there are slight fever, headache and lassitude, 
and it may be a little cough, for twelve to thirty-six 
hours previously. At first the spots are few, and usually upon 
the body, especially about the shoulders and chest, but sometimes 
the eruption is abundant. It extends, as the disease progresses, 
to the limbs, face and scalp, and is likely to become quite copious 
upon the latter. The spots are likely to be separate, but occa- 
sionally become confluent to the extent of several uniting in one. 
For five or six nights fresh crops appear, so that the eruption be- 
comes abundant and vesicles are present in all stages of maturity 
at the same time, in marked contrast to those of small-pox, which 
all mature at once; neither are they depressed in the center like 
those of small-pox, and when mature, if punctured, collapse com- 
pletely. ■ In some cases they are said to cause the skin to look 
as though it had been sprinkled with hot water. Sometimes the 
successive crops of vesicles continue to appear for ten or twelve 
days. Each vesicle either ruptures or dries up on the third to 
fifth day, the thin, crumbly scab rubbing off in particles, but 
occasionally a thick, tough crust is formed. Sometimes, but not 
often, distinct round or elliptical pits are left. A good deal of 
unpleasant itching is likely to be about the only disagreeable sen- 
sation. 

Treatment. — The disease of itself is never fatal, and the only 



DISEASES OF CHILDREN. 481 

treatment required is to keep the patient quiet, to restrict the diet 
to a few mild, easily digested articles of food, and to keep the 
bowels open. If there is fever it may be controlled, and the 
comfort of the patient promoted by a tepid sponge bath, repeated 
as often as may be required. All scratching should be restrained. 
If catarrh is present it should be treated. If the bronchial tubes 
become extensively affected the condition may be rendered dan- 
gerous, and an unsatisfactory state of health may cling to the 
patient for some time following an attack of varicella. 

PAROTIDITIS. 
(Mumps.) 

Mumps is an acute, specific, infectious, self-limited disease 
of the glands of the neck known as the parotid glands, and some- 
times of the testicles, breasts and vulva, and, rarely, of the 
ovaries. It is more common in boys than girls, and usually 
occurs between the ages of five and fifteen years, but sometimes 
attacks adults. Very young children are usually exempt. A 
person seldom has it more than once. It usually occurs in epi- 
demics, and in the spring or fall. 

The patient is attacked in from one to three weeks from 
the time of exposure. The first symptom is likely to be fever 
and general malaise, lasting from one to three days before the neck 
begins to swell and become tender, but sometimes the fever and 
swelling come at the same time. The swelling commences just 
below the lobe of the ear and back of the angle of the jaw, and 
extends in all directions, gradually increasing for two or three days 
until the neck and cheek are greatly disfigured. There is not 
likely to be much pain, but more or less uneasiness and a sense of 
tightness, which is increased by opening the mouth, chewing or 
swallowing; and it becomes difficult to speak or take food. About 
the fifth or sixth clay the swelling begins to subside, and in two or 
three days more disappears ; but as one side recovers the other 
is likely to become affected. In some cases both sides are attacked 
at the same time. A mild fever is usually present throughout 
the attack, but sometimes subsides when the swelling begins. 
The swelling may become very tense and hard, but it is quite 
rare that any pus forms. The hardness may last for some time, 
and gradually passes away. 

In about one-third of the cases of mumps, in boys at puberty, 

31 



482 DISEASES OF CHILDREN. 

less often in those younger, one or both testicles are attacked; 
and more rarely in girls the breasts and vulva, and sometimes the 
ovaries, are affected. An inflammation in these glands is not 
always present with mumps, and, when it is, usually appears in 
them later than in the parotids; it was long thought to be due 
to metastasis, which means leaving one part of the body to appear 
in another. The most recent investigators regard this theory 
as wholly insufficient to explain the fact, and with a better show 
of reason maintain that when these glands suffer it is because 
of their infection with the same germs that attack the glands of 
the neck and that, although they are usually attacked later than 
the parotids, they are often attacked at the same time, in some 
cases are attacked first, and that there are cases in which in- 
flammation of the testicles is the only manifestation of mumps. 
It is true that the inflammation is occasionally greater in one 
part, then in the other, alternating several times, but generally 
when it subsides in one part it does not appear in it again, and when 
it does return it is in the nature of a relapse, as from having taken 
cold. How the germs reach the testicles, and in fact any of the 
other glands, is not known. 

Treatment. — The patient should be kept in a comfortable 
room and, if the disease be at all severe, he should be kept in bed. 
Not much treatment is usually needed, but care must be used to 
keep him from taking cold. It may be well to give a mild cathar- 
tic, preferably salts, to promote the action of the skin and kidneys. 
The bowels should be kept regular throughout the entire course of 
the disease. The application of hot fomentations to the swollen 
neck was long recommended as the best treatment, but many now 
prefer ice bags or cold compresses until they become uncomfort- 
able, then to apply hot cloths for a little while, to be followed again 
with the cold, and so on alternately, until the inflammation sub- 
sides. 

Should a soft place, indicating the formation of an abscess, 
appear in the middle of the swelling, hot fomentations only should 
be applied to hasten it as much as possible, and as soon as pus 
has formed the lance should be used. Warm sponge baths, fol- 
lowed by brisk rubbing with dry towels, are an advantage. Any 
hard places that remain when the swelling subsides may be re- 
moved by rubbing with oil. When the testicles, breasts, etc., are 
affected the patient should be kept quiet in bed and the same 



DISEASES OF CHILDREN. 483 

treatment used as recommended for the neck. The inflamma- 
tion may lead to a wasting' of the testicles, but cases of this are 
rare and it usually subsides without any serious results. A sus- 
pensory bandage should be worn for the support of the testicles, 
when they are inflamed or swollen. Deafness sometimes, and 
meningitis very rarely, are caused by mumps. 

PERTUSSIS. 
(\\ hooping Cough.) 

Whooping cough is an infectious disease, due to specific 
germs belonging to that class known as bacilli. The disease has 
been transmitted to animals by inoculating them with these bacilli. 

Although the bacilli may be borne some distance in the air, 
the disease is chiefly transmitted through a close association with 
a patient suffering with it, the germs being given off abundantly 
in his breath and occurring also in his sputa and the secretions of 
his mucous membranes. 

There are now and then isolated cases, but it generally occurs 
in epidemic form, and is most common between the ages of one 
and eight years, but children of any age are subject to it. It 
rarely attacks adults, and it has been found that girls are more 
frequently affected than boys of the same age. It generally runs 
its course in from four to six weeks, but in rare cases has been 
known to last three or four months. 

Symptoms. — For convenience the symptoms have been di- 
vided into three stages : First. The Catarrhal Stage. The first 
symptoms are expected to appear in from six 10 fourteen days 
after exposure, but infants have sometimes shown the disease in 
three or four days. At the commencement there is usually some 
fever and signs of catarrh, such as running from the nose, sneez- 
ing, redness of the eyes and frequent fits of severe coughing. At 
the beginning the cough is dry, but it is soon attended with ex- 
pectoration of a peculiar, tough, stringy, transparent mucus. This 
stage lasts from a few days to two or three weeks, or even longer, 
its duration and intensity indicating the probable length and 
severity of the entire attack. 

Second. The Spasmodic Stage. In this stage peculiar fits 
of spasmodic coughing attended by whooping are the most promi- 
nent features. The coughing spells come on suddenly and are 
very severe. The child is likely to run to some near object and, 



484 DISEASES OF CHILDREN. 

seizing it for support, to give a number of short, rapid, spasmodic 
barks or puffs, until the lungs are emptied of air, when 
a clear, shrill, whooping sound is heard, caused by a 
spasmodic condition at the entrance of the windpipe while 
air is drawn forcibly into the lungs. The coughing and 
whooping may be repeated a number of times in close succession 
until the child turns blue in the face, the eyes bulge out, the tears 
flow, the breath seems lost, and there is great exhaustion. 

Each coughing spell generally ends with spitting a quantity 
of thick, sticky, clear fluid or mucus, and sometimes with vomiting. 
The coughing may be so severe as to cause bleeding from the 
eyes, nose, mouth, ears or rectum; or to produce hernia or 
rupture. The whooping above described is the most characteris- 
tic sign and when heard dispels all doubt as to the nature of the 
disease. In infants of less than six months, and in very mild 
cases in older children, whooping may not occur, but these patients 
transmit the disease to others as certainly as those who whoop. 
The diagnosis of a case of this kind must be determined by the fact 
of exposure, the nature of the coughing spells, which are likely 
to be more frequent at night, and the character of the expectora- 
tion. If with the cough the infant spits abundant mucus whoop- 
ing cough is positively indicated. 

Third. The Declining Stage. There is a gradual lessening 
in the frequency and violence of the coughing spells, expectoration 
becomes more easy, and the mucus thrown out becomes opaque 
■ or yellowish ; vomiting ceases ; the general health improves ; little 
by little the coughing ceases until it is gone entirely ; and the pa- 
tient may soon be well, but the disease is so prone to relapse great 
care must be taken to guard against a secondary attack. 

Treatment. — The patient should have two rooms, one for the 
day, the other for the night, and each room when not in use must 
be thrown open and most thoroughly aired, and both rooms 
at all times must be well ventilated. If impossible to give the 
patient two rooms, he should be covered up warmly in bed and 
his head protected from draughts and cold air by a shield, as that 
formed by a raised umbrella placed over him and covered with a 
blanket, while the doors and windows are thrown open, twice every 
day, until the room is well aired and again warmed to about 68 
degrees, at which temperature it should be kept as nearly as pos- 
sible. There should be a current of pure air passing through 



DISEASES OF CHILDREN. 485 

the room at all times, care being used to protect the patient from 
draughts, and the bedding and clothing must be kept fresh and 
clean by frequent changes. 

The patient should be dressed warmly with flannels next the 
skin, and if the weather is warm should spend much of his time 
in the open air. Long before the true nature of the disease was 
discovered, outdoor life was known to be much more favorable 
than a close room to an early recovery. 

Moncorvo, who has had large hospital experience in the 
treatment of this disease, believes that it begins in the larynx, and 
applies resorcin to it with a throat brush having a flexible wire 
handle, introducing the brush four or five times at each treat- 
ment and using care to reach all parts in the back of the throat 
and about the glottis. By this method he claims to have been 
able to cut short an attack of whooping cough, often quite sud- 
denly and in some cases within twenty-four hours. If the chemi- 
cally pure resorcin cannot be obtained, he uses instead a ten 
per cent solution of citric acid as a spray by means of an atomizer. 

Schmid advises the use of the following mixture as a spray 
every three hours, the nozzle of the atomizer being directed as 
far back in the mouth and throat as possible : 

Carbolic acid six grains 

Menthol (4 per cent solution) four drams 

Cocaine (3 per cent solution) three drams 

Glycerin one dram 

Cherry-laurel water one ounce 

In my own practice I use the following with good results : 

' Belladonna one-half dram 

Sodium bromide one dram 

Carbolic acid sixteen drops 

Glycerin one-half ounce 

Enough syrup of tolu to make two ounces. 

Dose. — One-half teaspoonful every two hours for a child two 
years old. 

Braro thinks the essential oil of cypress an excellent remedy, 
and uses it by dropping some on the pillow and the patient's collar 
so that he shall constantly inhale it. 

The best protection against attacks of other diseases is in 



486 DISEASES OF CHILDREN. 

building up the general health and making the surroundings as 
perfect as possible. 

The diet should receive careful attention and consist of liquid 
foods and be nutritious, and the bowels should be kept regular. 
Means should also be used to prevent the patient from throwing 
off the bed clothes at night and thus exposing himself to cold. A 
moist atmosphere, as that caused by steam escaping in the room, 
is desirable, and vapor baths and inhalation of steam are often very 
useful. The child should be taught to suppress coughing as much 
as possible, for, as it irritates, the more he coughs the more he 
will want to cough. Complete change of air, as a trip to the sea- 
shore, or a sea voyage, is often very beneficial, but respect for the 
rights of others and recognition of the dangers of spreading the 
contagion should prevent using any public conveyance for that 
purpose. 

Many careful investigators have inclined to the opinion that 
whooping cough is an auto-infectious disease, that is, that a patient 
when nearly well may become infected again, from germs thrown 
off by himself, and consider that the demonstration of this fact, first 
advanced by Musser, explains many of the most serious, prolonged 
and relapsing cases, but this view is not fully established, and the 
weight of authority is that the relapses are caused by exposure to 
cold, in some cases very slight. 

SPASMODIC OR FALSE CROUP. 

Other names for this disease are Catarrhal Spasm of the 
Larynx, Spasmodic Laryngitis and Catarrhal Croup. It is a dis- 
ease which may occur at any time, but is most prevalent during 
spring and autumn, when the weather is changeable and rather 
cool. Infants between six months and three years old are most 
frequently affected, although it is occasionally met in older and in 
younger children. There are certain ones who are prone to the dis- 
ease, especially rachitic children, and one attack is very apt to be 
followed by another. Some families have it more often than 
others, although it is not contagious and cannot be communicated 
from one child to another. Enlarged tonsils and adenoid growths 
in the pharynx predispose a child to false croup. The disease at- 
tacks the larynx just above the vocal cords. 

Symptoms. — At first there is a dry condition of the throat 
which is followed by an abundant secretion of mucus. The 



DISEASES OF CHILDREN. 487 

symptoms are so marked and peculiar that anyone who sees a 
case can always recognize it thereafter. The child goes to bed 
as well as usual, or with a slight cold, which shows itself by a 
little hoarseness and, perhaps, by a slight running at the nose, the 
throat may be a trifle sore, and sometimes there is just a little 
fever. Having slept until about midnight the child suddenly 
awakes with a deep, hoarse, choking cough, and every inspiration 
labored, hoarse and noisy. The face usually has an alarmed ex- 
pression, and the patient often clutches at its throat as if to re- 
move some obstruction there. At times it grasps the bedstead 
or the bed-clothes, or if its mother is near clings to her, as if that 
afforded relief. Sometimes the distress is very great, but at other 
times it may not be enough to keep the child awake. There may 
be a slightly livid condition of the lips and fingers, but at other 
times the child is pale. Perspiration starts from the face and 
body and there is presented a most distressing picture. 

The attack may last from one to four hours, and when it 
subsides the child goes back to bed and to sleep, although there 
is still some hoarseness in its breathing. Frequently a second 
attack will come on the next night, similar to the first but less 
severe. The third night seldom brings another attack, and from 
this time the child rapidly recovers, and in from four to seven 
days is well. It does not appear very sick except during the 
attack and the fever seldom rises above 101 degrees. Another 
attack is very apt to occur the first time that the child takes cold. 

False croup may be confounded with true or membranous 
croup and laryngismus stridulus. From membranous croup it 
is distinguished by the sudden and nightly onset, also by the 
mildness of the symptoms after the acute attack, and their 
daily remission. There having been a previous attack aids 
in the diagnosis. The inhalation of chloroform quickly relieves 
in false croup, but affects membranous croup very little. 

False croup is distinguished from laryngismus stridulus by 
the facts that the latter attacks infants only, that it sometimes 
stops the breathing entirely, and its attacks come on many times 
a day and may continue for weeks. 

In false croup the outlook is very favorable, as it is doubtful 
if death ever occurs from it, unless it be complicated with some 
other disease. 

Treatment. — This consists of the prompt use of emetics, 



488 DISEASES OF CHILDREN. 

steam and hot fomentations around the neck. Hive syrup or the 
compound syrup of squills is the remedy most frequently used, 
and it should be kept on hand constantly when in the family 
there is a child subject to this croup. One-half teaspoonful 
can be given a baby one year of age every ten or fifteen minutes 
until vomiting occurs, or until the distressing symptoms subside. 
It is well, at the same time, to wrap a flannel cloth wrung out 
of hot water around the throat, and if the croupy breathing 
continues to have the child breathe steam. This may be accom- 
plished by making a sort of tent over the child with a sheet 
and allowing steam from boiling water to flow into it; or a large 
cone can be made from a newspaper and held over the spout 
of a tea-kettle, and the child allowed to breath the steam escaping 
from the small end of the cone, care being used that the steam 
shall not be hot enough to scald the patient. 

The following prescriptions are useful, either during the 
severe attack or after it : 

Wine of ipecac one dram 

Tincture of aconite two drops 

Syrup of tolu three drams 

Liquid acetate of ammonia one ounce 

Dose. — One teaspoonful every two hours to a child of three 
years. 

Antipyrin sixteen grains 

Syrup of ipecac one dram 

Bicarbonate of soda sixteen grains 

Syrup of tolu enough to make two ounces 

Dose. — One teaspoonful every two hours to a child three or 
four years old. 

SCROFULA. 

Scrofula is a disease of the lymphatic glands, usually those 
of the neck, which are thereby caused to enlarge and suppurate. 
The affection is so well known and so easily recognized that a 
description is hardly necessary. 

Causation. — Scrofula is really a form of tuberculosis, being a 
tuberculosis of the lymph glands, as consumption is a tuberculosis 
of the lungs, and hip-joint disease a tuberculosis of the hip-joint. 
All are due to the germ known as the bacillus tuberculosis. The 



DISEASES OF CHILDREN. 

disease is very often hereditary, and attacks children between the 
ages of three and ten almost exclusively. Although so frequently 
handed down from parent to child, there are other factors which 
aid its development in those having the hereditary taint; such 
as a cold, damp climate, poor food, bad air, crowded tenements, 
and, in short, whatever tends to lower the vitality of the body. 
It is a disease frequently seen in the overcrowded poor quarters 
of the city, but rarely in the pure air of the country. It may be 
brought on by tonsilitis, measles, scarlet fever or influenza. 

Symptoms. — Scrofula is always a chronic affection. In the 
great majority of cases the glands of the neck only are affected, 
but it sometimes involves those of the arm-pit and groin. At 
first the only symptom is the swelling of the glands of the neck, 
and both sides are usually affected, though one side may begin 
first or grow more rapidly. The enlargement does not go on 
continuously, but at times increases rapidly (in which case the 
affected glands are often painful), then again remains stationary. 
The progress of the disease is very slow, lasting from several 
months to several years, three and a half years being the average 
duration. The glands generally reach considerable size in three 
or four months, and although at first they are smooth and reg- 
ular in shape, and move freely under the skin, later they grow into 
the surrounding parts, become immovable and take on irregular 
nodular shapes. AYhen a chain of glands is affected, the course 
is slower and the glands do not adhere to the neighboring parts. 

Suppuration takes place in from one-half to two-thirds of 
all cases. The cases which do not suppurate improve about the 
age of puberty. When the tumor breaks down and discharges 
pus, there is formed a large open ulcer which is extremely diffi- 
cult to heal, and when finally healed leaves a large, irregular, 
unsightly scar, which may break down into another ulcer. Such 
scars may contract to form prominent ridges which are as sensi- 
tive and painful as burns. A child with scrofula may be otherwise 
healthy and remain in good condition throughout the disease. 

Prognosis. — This is not a fatal disease, and though the case 
may drag on for eight or ten years, recovery can be safely pre- 
dicted ; neither does it often lead to tuberculosis of the lungs, 
but sometimes does. 

Treatment. — The treatment must be much like that of other 
forms of tuberculosis. A drv climate and a moderately high 



490 DISEASES OF CHILDREN. 

altitude are helpful. Plenty of pure air and nourishing food are 
necessary. Of medicines, cod liver oil and the syrup of iodide 
of iron are the best combination, a dessertspoonful of the former 
with twenty to thirty drops of the latter, three times a day, may 
be given a child of five years. An emulsion of cod-liver oil may 
be more readily given a child, but it is not as efficient as the 
pure oil. 

The enlarged glands will often require the attention of a 
surgeon. When pus forms in a gland it should not be allowed 
to go on till it breaks, but should be opened at once, for thus, 
by a simple, timely operation, the course of the disease may be 
shortened, and the formation of ugly, disfiguring scars prevented. 
Poulticing and painting with iodine are harmful. 

RACHITIS OR RICKETS. 

Rachitis is a disease of nutrition and is characterized by 
changes in the bones and a variety of nervous symptoms. It 
is largely a disease of infancy, particularly of children from six 
months to three years of age, but may occur earlier and some- 
times later. It is far more frequent in the city than in the country, 
and among the poor than among the well-to-do. It seldom 
occurs in a child nursing a healthy mother, and is most likely to 
be found in one poorly cared for and fed upon improper food, 
especially food that is deficient in fat. Infants under one year 
of age that are brought to the table and fed the same food as adults 
are prone to the disease. While there is no evidence that rachitis 
is inherited, children born of weak parents, or parents infected 
with syphilis or tuberculosis, or having some purulent discharge, 
are more susceptible than those of healthy parentage. 

Symptoms. — The symptoms are many and varied, but cer- 
tain ones are most likely to occur, and upon these we can usually 
base a diagnosis. The first one noticed is persistent fretfulness. 
The child acts as if it were sore all over, and any pressure or 
sudden movement makes it cry. Its sleep is intermittent and 
disturbed and there is often a little fever at night. The child 
also sweats at night, or whenever it sleeps, the perspiration being 
especially profuse about the head. In its restlessness it is apt 
to throw off the covers, and, being wet with sweat, to take cold. 
Indeed, catarrhal diseases of all kinds, whether they affect the 
nose, throat, lungs, stomach or intestines, are frequent and severe 






DISEASES OF CHILDREN. 491 

in a rachitic child. It is pale and sometimes sallow. The veins 
about the face are enlarged and plainly visible. Craniotabes 
(a thinning of the bones of the skull) sometimes occurs and is 
a serious symptom, because it often excites disease or injury of 
the brain. If such a child is laid upon a bed with a hard pillow, 
the weight of its head causes pressure on the brain that may give 
rise to severe symptoms, and always causes it much pain. It is 
always desirable to change the position of such children often, 
for they are usually so young as to be unable to do it for them- 
selves. It is probably this condition which makes rachitic chil- 
dren so susceptible to nervous diseases of all kinds. Convulsions 
are frequent among them, and at times tetanus occurs ; the teeth- 
ing is retarded; the fontanels remain open until the child is two 
or three years old, and walking, and even creeping, is long delayed 
and difficult. 

To the bones the rachitic condition proves extremely disas- 
trous and many and severe are the deformities. These result from 
inability of the bones during the rachitis to appropriate the lime 
salts, which form the hard part of the bones, and they therefore 
soon assume a gristle-like condition, so that nearly every bone 
in the body is liable to become bent out of shape. Those of 
the legs bend out or in, giving rise to bowlegs, and sometimes 
the shin-bone bends forward. The chest is likely to become dis- 
torted into the so-called pigeon breast, or an unsymmetrical one. 
The head bones also may bend and cause a square-shaped head, 
or one with protrusions, making it look abnormally large. 

If these deformities become fixed, and they usually do after 
the third or fourth year, a surgical operation is needed to correct 
them. Much can thus be accomplished. The bone is cut or 
broken and done up correctly, and when the new bone forms, 
between the severed ends, it fixes the bone in the proper position. 
Earlier than the third or fourth year the legs and arms may be 
bent and held in position by braces until they become fixed by 
new bone formation. 

Rickets is not of itself a fatal disease. Its great danger lies 
in the deformities it causes, and its tendency to increase the 
liability to other diseases of a severe and dangerous character. 
It is said that in Europe nearly thirty per cent of the infants 
show some symptoms of rachitis, and in the large cities of America 
the number thus affected is about twenty per cent. It is therefore 



492 DISEASES OF CHILDREN. 

desirable that we be able to early recognize the disease and 
begin its treatment promptly. 

The best treatment is the preventive treatment, and that 
consists of giving the proper food at proper times in proper quan- 
tities amid the best possible hygienic surroundings. These things 
have been treated under the heads of "Infant Feeding" and "Diet 
of Infants," and to these the reader is referred. It is also of 
great importance that the mother while carrying the babe should 
have good care. Good, nourishing food, fresh air, proper baths 
and abundant sunlight, all are necessary for her. 

After the disease has become established, medicinal treat- 
ment is important, and, fortunately, it is usually effective. As 
there is indigestion as a rule, some digestant is desirable, as pan- 
creatin and soda, or papoid tablets, one after each meal. In 
older children pepsin and muriatic acid are at times better — 
Parke, Davis & Co.'s Pepsin Cordial, a teaspoonful before each 
meal. For infants, maltine with hypophosphites of lime, iron 
and soda is excellent, both as a tonic and as a digestant of the 
starchy foods. One of the emulsions of cod liver oil is recom- 
mended, not only on account of the fat it contains, but also for 
its bile salts. Parke, Davis & Co.'s Egg Emulsion is especially 
useful, as it possesses food qualities also. Some form of phos- 
phorus is useful in this connection to help the formation of bone, 
and Fairchild Bros'. Elixir of Calisaya Phosphorized is a val- 
uable one, being a good tonic in addition to its phosphorus. 
Everything should be done to promote a good, healthy action 
of the digestive organs and increase the nutrition of the child. 



OBSTETRICS, 

OR THE CARE OF WOMEN IN PREGNANCY, CHILDBIRTH AND 

RECOVERY. 

By Ida C. Barnes, B.A., M.D. 

CHAPTER I. 

In studying the subject of obstetrics, the phenomena at- 
tendant upon pregnancy and childbirth will be considered, as also 
the relation of the fetus to the maternal surroundings. 

Whenever to a woman comes the opportunity of presiding 
over a home of her own, consequent upon matrimonial obligations, 
she must consider the almost certain, and certainly to be desired, 
family which shall surround her in a few years, her own mental 
and physical adaptation for such duties, and the fitness of the man, 
mentally, morally and physically, whom she accepts as the father of 
her children. If with tastes and mental attainments more or less 
in opposition, there is yet a broad-minded tolerance of the opinions 
of others, there may be a most pleasant marriage ; but if a spirit of 
intolerance exists, sooner or later there will be discord to mar the 
otherwise pleasant relation. 

People debilitated by constitutional disease, either hereditary 
or acquired, ought not to entail their tendency to weakness upon 
the oncoming generations, and should make every effort for as 
complete restoration to health as possible. Much can be done by 
proper living to increase the power of resistance to exposure and 
disease, and it is the great duty of all, by working towards this end, 
to raise both the physical and mental standard of the human race. 
A nation is not what its strongest men are, but what its count- 
less thousands average in ability and strength, and it should be 
remembered that all excesses, whether in the pursuance of pleasure 
or gain, that sap the health and impair vitality will prove a curse 
to those to come. 

PELVIC ANATOMY. 

Preliminary to the consideration of obstetrics, it is important 
to understand something of the anatomy of the pelvis — the great 

493 



494 OBSTETRICS. 

bone framework of the lower part of the body — and its adaptation 
to childbirth. It is composed of four bones : The two os in- 
nominata or "hip bones," forming its two sides and, by uniting, 
also forming its front ; the sacrum (consisting of live joints of the 
spinal column fused together into a single bone) forming its 
rear, and the coccyx (the rudimentary human tail composed of 
the last four sections of the spinal column, also fused together into 
one bone) attached to the lower end of the sacrum and helping 
to form the pelvic cavity, although not a part of the pelvic brim. 
In addition to these, the obstetric pelvis also includes the last 
lumbar vertebrae (the sections of the spinal column just above the 
sacrum). 

Complete union of any of these bones does not occur until 
the twentieth year, the sacral and coccygeal segments fuse still 
later, and the sacro-coccygeal joint does not unite until middle 
life. Do not be frightened by these large words ; they simply 
mean that during the larger part of the child-bearing period, there 
is more or less elasticity of the joints, capable of being utilized 
during childbirth. 

The mechanical part of labor resolves itself into two factors 
which may be expressed as follows : The size of the natural 
pelvis, with the possibilities of expansion under pressure, and the 
size of the fetal head, which is the largest part of the fetal body, 
with the possibilities of compression under pressure. 

PELVIC DEFORMITY. 

Like other portions of the body, the pelvis is modified by 
heredity and mode of life. The pelvis of the average American 
woman, though not presenting the striking deformities found in 
some countries, is not perfect, and protracted labor is often due to 
some failure of development which has destroyed symmetry and 
lessened a diameter at a point where full size is most needed to pro- 
mote an easy delivery. A lack of nutrition before birth may be 
followed by a similar deficiency after birth, from which all the 
bones suffer imperfect development, and the pelvis, by a dimin- 
ished capacity, is so seriously crippled as to be unfitted for child- 
bearing. .Again, a pelvis may present a fair degree of symmetry, 
yet be so contracted in all its diameters as to seriously diminish 
the size of the birth canal. During infancy and childhood the 
bones are so soft and pliable that continued pressure upon any 



OBSTETRICS. 495 

point will deflect some bone from its natural inclination and change ' 
the angle it should form with some other bone, and thus may 
seriously interfere with the function of childbirth or labor. 

Then there is the flat pelvis, narrowed from the front back ; 
and the funnel-shaped, clue to restrained growth, resembling the 
infantile and the male pelvis. The pelvis of the female is essen- 
tially like that of the male until puberty (about the fourteenth year 
of age), when the uterus and ovaries develop rapidly and the bones 
of the pelvis enlarge and expand; while the male pelvis remains 
deep and narrow, and its bones increase in strength and firmness. 
A partial dwarfing of the body often results only in lack of pelvic 
development, and the formation of a frame not totally unfit for 
maternity, but which will not permit normal labor. An oblique 
pelvis may be caused by a deformity in the spine or hip, or a short- 
ening of one \tg by improper standing or sitting at work or study. 
In early infancy, any of the pelvic deformities may be caused, in an 
otherwise healthy individual, by allowing the baby to sit or stand 
before it is able. Improper feeding may result in soft bones that 
will bend under the burdens borne by the average child of the 
same age. A woman with crooked bones may, with comfort to 
herself, accomplish the ordinary duties of life, but she cannot bear 
a child through a deformed pelvis without great suffering and 
much peril to herself and babe. Shall not woman crown her high- 
est physical endowment with as perfect development as possible? 

Although heredity may have marred with sad defects, it lies 
within the power of every individual, by careful and wise observ- 
ance of nature's laws, to greatly modify the baneful results. 
Diseases, especially those caused by lack of nourishment in early 
life, play havoc with the bone framework of the body, and here 
again, unless great care be taken, the female pelvis will suffer 
as regards child-bearing; it may be one-sided, narrow or flat, yet 
not seriously interfere otherwise with its relations to the rest of the 

bodv. 

THE ORGANS OF GENERATION. 

The immediate organs of generation, or child-bearing, are 
the ovaries and the uterus, or womb, situated just above the 
plane of the strong muscular floor of the pelvis, slnd connecting 
with the external organs of generation by means of the vaginal 
canal, which penetrates this floor in its front portion. The exter- 
nal organs of generation are the mons veneris, the labia majora 



496 OBSTETRICS. 

(greater lips) and labia minora (lesser lips), the clitoris with its 
prepuce, and the vestibule upon which is found the urethral open- 
ing. 

The labia majora are two thick folds of hairy skin extending 
from the symphysis pubis backward to within an inch of the anal 
orifice, each lip having an outer and an inner surface, and including 
within its folds blood vessels and a quantity of fat. When they 
are best developed they unite in front in what is known as the 
mons veneris, while posteriorly they join in a mere fold of skin 
known as the fourchette. In the adult the outer surface of both 
lips is thickly covered with hair. 

The labia minora are two thin oblique folds of skin on the 
inner surface of the larger lips, and blending with them at about 
the middle of their inner surface behind, but in front separating 
each into two folds, of which one unites with the corresponding 
fold of the opposite lip to form the prepuce of the clitoris, while 
the other joins with its opposing mate to form the suspensory liga- 
ment. As a rule the smaller lips do not project beyond the 
larger. 

The clitoris, covered by its prepuce, lies in the middle line and 
at the apex of a piece of mucous membrane called the vestibule — 
a smooth triangular surface bounded above by the clitoris, at the 
sides by the lesser lips, and below by the upper edge of the vaginal 
opening. In the middle at the base line can be seen the urethral 
orifice. There are mucous glands also upon its surface. 

The pelvic floor is a thick, fleshy, elastic layer of tissues 
attached to the bony pelvic outlet, on the outer skin aspect of 
which lie the external organs of generation just described, while 
on its inner, peritoneal surface lie the uterus and its appendages — 
the Fallopian tubes and ovaries. 

The vaginal opening lies in the middle line between the lower 
edge of the vestibule and the uniting folds of the larger lips behind. 
Stretched across the rear part of this opening and partially cover- 
ing it is the hymen, which consists of a thin fold of mucous mem- 
brane strengthened by some connective tissue, with blood vessels 
and nerves. It varies in shape, and is generally, though not always, 
ruptured at the first copulation, and it may remain intact even 
until childbirth arrives, then become a source of obstruction ; but 
usually it is easily ruptured. It may be attached to the lower edge 
of the vaginal opening, or it may be attached. all around and 



OBSTETRICS. 497 

contain a small hole or vertical slit. Sometimes it has no opening, 
in which case abnormal conditions result. 

The vagina is a muscular membranous canal, lying chiefly 
within the pelvis, its lower end passing through the pelvic floor. 
It rises at an angle of 60 degrees with the horizon, when the body 
is in the erect position, and is in relation with the bladder and 
urethra in front, and the rectum behind, being separated from 
them only by partitions called the vesicovaginal and recto-vaginal 
septa. The vagina extends from the external opening below to 
the neck of the uterus above, and is very dilatable as by manipula- 
tion or childbirth. Its front wall is about two and a half inches 
in length, its back wall nearly three inches, and, ordinarily, the two 
lie in contact. Its walls are composed of mucous membrane and 
a muscular and fibrous coat, and are abundantly supplied with 
lymphatics, blood vessels and nerves. 

The female urethra is short, being only about two and two- 
thirds inches in length; it lies beneath the front bone of the 
pelvis and is firmly imbedded in the front vaginal wall. The 
bladder bears an important relation to the vagina and uterus. 
When empty and relaxed it lies entirely within the true pelvis be- 
hind the pubes (the front part of the two pelvic bones known as 
the os innominata), and usually to one side. When filled to its 
•greatest capacity the bladder, together with the peritoneum, is 
pressed well above the pubes, and has a consequent tendency to 
backward displacement of the body of the uterus. As disorders 
of the rectum are often important factors in uterine disturbances 
its location should also be remembered. It extends from the 
upper part of the left side of the pelvis to the anus ; and in its 
course curves backward and inward. The anus, its external 
opening, is about an inch in length. 

THE UTERUS AND ITS CONNECTIONS. 

In shape the uterus is a triangular ovoid, consisting of a body 
and neck, and containing a cavity whose front and back walls rest 
upon each other. At each of its three angles there is an opening — 
the Fallopian tubes at the two upper ones and the vagina at the 
lower end. The neck of the uterus (cervix) opens into the uterus 
above and into the vagina below, and is divided into two portions, 
the vaginal, which extends down into the vagina, and that above 
the vagina. The virgin uterus measures about three inches in 
32 



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OBSTETRICS. 



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OBSTETRICS. 499 

length, one and a half inches at its greatest width, and one inch in 
thickness, and consists of two portions — the body and neck. 
The proportion between them varies with age. In the adult vir- 
gin the two parts are nearly equal, while in early life the neck 
preponderates over the incompletely developed body; after child- 
birth the body remains nearly twice its original size, and in old 
age the organ becomes diminished to less than its virginal pro- 
portions. The cavity of the uterus is narrow and cleft-like, while that 
of its neck tapers at both ends and is bounded by the internal and 
external mouths, the internal mouth being the point of greatest 
contraction of the uterine canal. 

The uterus is composed of a serous or external coat called the 
peritoneum, which covers only partially its external surface ; the 
mucous membrane which lines the cavity of the body and neck, 
and the muscular layer which is between the other two, makes 
up the largest part of its constituency, and is of peculiar interest to 
the obstetrician because of its adaptation to the function of expell- 
ing the mature fetus, also because the contraction of this circular 
layer of muscular bands closes large blood vessels, thus preventing 
serious hemorrhage after childbirth. 

The uterus is held in place by the broad, round, utero-sacral 
and utero-vesical ligaments. The broad ligaments are formed 
by layers of peritoneum, which partially cover the uterus in front 
and behind, and at the sides extend outward and somewhat back- 
ward to the sides of the pelvis. In the upper free margins of these 
ligaments are found the Fallopian tubes and the ovaries, and be- 
tween the layers of the ligaments lie connective tissue, muscles, 
blood vessels and lymphatics. 

When the uterus is in a normal position, that is, inclined 
slightly forward, the broad ligaments extend out laterally and 
backward nearly horizontally, but displacement of the uterus 
causes their displacement, and in pregnancy they are drawn up- 
ward until they assume an almost vertical position. By scarring 
and contracting the tissues, attacks of inflammation may also 
draw the uterus to one side and move the ligaments from their 
natural position. 

The round ligaments are two in number, and, attached to the 
upper part of the uterus, extend obliquely forward and fasten 
to the front part of the pelvic bones. They receive lateral support 
from the folds of the broad ligament through which they pass. 



500 ' OBSTETRICS. 

The utero-sacral ligaments are folds of peritoneum extending 
from the lower part of the sides of the uterus, backward to the 
second sacral vertebra. The peritoneum, as it passes between the 
uterus and the bladder, forms the utero-vesical ligaments. 

The mucous membrane lining the cavity of the uterus is, in 
the unimpregnated, about one-twenty-fifth of an inch in thickness, 
and is set upon the muscular layer without any intervening sub- 
mucous tissue. There are numerous glands. The mucous mem- 
brane lining the uterus is different from that lining its neck, and 
that covering the vaginal portion of the neck externally differs 
from both of them. 

In normal position, the uterus is toward the front of the 
pelvis, supported, as we have seen, by flexible ligaments on all 
sides, and, resting with its top against the bladder, bends further 
forward when that organ is empty, and straightens up with its 
distention. The great pliability of the uterus, designed as it is for 
the protection and nourishment of the fetus during intrauterine 
development, renders it peculiarly liable to displacements and mal- 
positions. 

The Oviducts or Fallopian Tubes extend from the upper 
angles of the uterus, within and along the free margins of the 
broad ligaments for a distance of about four inches to the sides 
of the pelvis and the vicinity of the ovaries, where they end in ex- 
panded, funnel-shaped openings surrounded by a series of fringed 
processes called fimbriae, one special fimbria running to each ovary. 
The function of the oviducts is to catch the ova as they come 
from the ovaries, and convey them to the uterus, and, preparatory 
to this, their fringed extremities have the peculiar faculty of at- 
taching themselves to the ovaries whenever an ovum has ripened 
and is about to be expelled. 

The oviducts have the three coats, serous, muscular and 
mucous, common to all cavities. The epithelium which lines these 
tubes is continuous with the epithelium of the peritoneum which 
lines the abdominal cavity, and thus indicates one source of in- 
fection from the outside to which women are liable and men are 
not, since in the male sex the peritoneum is a closed sac. The 
caliber of an oviduct where it enters the uterus, which is its nar- 
rowest point, will scarcely admit a bristle, but it gradually expands 
toward its outer extremity, where it becomes from fifteen to 
twenty-five hundredths of an inch in diameter. 



OBSTETRICS. 501 

THE OVARIES. 

The two ovaries are flattened ovoid masses, usually about one 
and a fourth inches long, three-fourths of an inch wide, and a half 
inch thick, attached in front to folds of the broad ligaments which 
extend from the uterus to the sides of the pelvis. The smaller end 
of each ovary is also united to the uterus by a muscular band called 
the ovarian ligament, and a small ligament running from the 
oviduct to the side of the pelvis gives additional aid in retaining 
the ovary at its proper level in the pelvis. It may thus be readily 
understood that contraction or relaxation of these ligaments leads 
to serious results in the form of displacements. 

Each ovary consists of the cortex or outer part and the 
medulla or central mass. The cortex includes the Grafhan folli- 
cles, which are the most important part of the ovary, for within 
them are formed the ova (eggs). These are found in all stages 
of development, but when mature the follicle reaches the surface 
of the ovary and its ovum escapes through a rupture of the sac. 
The production of ova is very nearly complete at birth, few being 
formed later, and perhaps none after the second year. The 
ovaries of the child, therefore, possess the full quota, estimated 
at about 70,000. It is probable that a variable number of them 
reach partial development before puberty, but at the arrival of 
sexual maturity the full and regular development of the Graffian 
follicles and their ova begins, attended by menstruation. During 
the child-bearing period these follicles are constantly developing 
and end by bursting, thus liberating the ripened ova, each follicle 
producing one ovum. It is thought that this liberation of the 
ova coincides with the menstrual periods, although it has been 
shown that ovulation may take place independently of it. The 
ripened human ovum is a spherical cell about seventy- five thou- 
sandths of an inch in diameter, containing granular protoplasm 
in which lies a nucleus (the germinal vesicle) containing a nucle- 
olus (the germinal spot). 

RELATION OF OVULATION AND MENSTRUATION. 

At regular intervals during the child-bearing period the 
lining of the uterus undergoes changes, designed to prepare a 
favorable resting place for the ovum in case of conception. The 
menstrual cycle, usually occupying twenty-eight days, may, ac- 
cording to Marshall, be divided into four stages, as follows : 



502 ' OBSTETRICS. 

(i) The constructive stage, a preparation for the reception 
of the ovum, during which there is swelling of the mucous mem- 
brane, enlargement of the uterine glands and increase of con- 
nective tissue. This stage lasts about a week, and when preg- 
nancy does not occur is followed by: 

(2) The destructive stage, in which there is a discharge of 
mucus, blood and disintegrated mucous membrane. Five days 
is the usual length of this period. 

(3) The reparative stage, in which the deeper, unaffected 
portion of the uterine mucous membrane forms a superficial 
membrane. This period lasts about four days. 

(4) The quiescent stage, including the remaining twelve to 
fourteen days preceding the beginning of the next cycle. 

The relation of ovulation and menstruation is of much inter- 
est. It has been proven that menstruation can take place without 
the liberation of an ovum. Marshall believes that the constructive 
stage is related not to the ovum of that period, but to the one 
discharged during the preceding cycle. The congestion of the 
ovaries attending ovulation leads to stimulation and engorgement 
of the uterus, which no doubt is a cause of menstruation. 

FERTILIZATION OF THE OVUM. 

The ripe ovum is ready as soon as it leaves its follicle for 
fertilization by the spermatozoon, or male element. The process 
usually takes place in the upper portion of the oviduct. The 
period during which the human egg retains the possibility of 
fertilization is estimated at about . eight days, since the death 
of the unfertilized ovum usually occurs before reaching the uterus. 
The union of the male and female pronuclei (generative ele- 
ments) results in the formation of a new nucleus, called a segmenta- 
tion-nucleus, in which the process of cell division at once begins 
and multiplies until membranes, tissues, organs, bones, nerves 
and muscles are formed and properly adjusted to make a perfect 
physical being. In this union of the male and female elements 
to form the first cell we see why the child should partake of the 
characteristics of both father and mother. 

STAGES OF THE EMBRYO AND FETUS. 

Very few human ova have been examined in their first stages, 
the earliest reported being at the twelfth day. This ovum had 



OBSTETRICS. 503 

become a flat, elongated vesicle one-fifth of an inch in length 
and one-eighth of an inch in thickness. A patch of thickened 
cells formed a rudimentary layer. The earlier processes of 
cell division have never been observed in the human ovum. 
On the thirteenth and fourteenth days the expansion for the 
head first becomes apparent. In the third week the form of the 
embryo becomes more definite, brain and optic vesicles and audi- 
tory sacs are distinguished, and by the twenty-first day the first 
rudiments of limbs appear. The fourth week is marked by 
increased size and more distinctive features; growth being more 
active at this period than at any other. With the third week 
the embryo is straight, but in the next few days the curves 
characteristic of the fetus are formed very rapidly. The indi- 
vidual brain cells, eyes, ears and nose, as well as the arches and 
furrows for the chest and abdomen, appear ; the heart has increased 
in size and the limb buds have become more prominent. During 
the latter part of the fourth week a series of prominences along 
the line of the back is seen, indicating the position of the spine. 

The fifth and sixth weeks add to the size and general growth. 
The limbs are the most characteristic feature of the period, their 
buds developing into distinct parts. Toward the close of the 
fifth week the flattened terminal parts, representing the future 
hands and feet, show thin marginal plates and soon exhibit 
traces of fingers. The upper limbs appear sooner than the lower 
ones. By the middle of the sixth week the fingers project 
beyond the hand, although the toes are just beginning to be 
outlined. The general development of the embryo has steadily 
continued; the head, although proportionally large, has gained 
little in size; the boundaries of the mouth are located, and the 
external parts of the eye, nose and ear are well advanced, the 
bend in the neck is disappearing and the face shows distinct 
advancement; the limbs project from the body and the fingers, 
thumbs and toes are well defined. 

At the close of the second month the fetus is from one to 
one and three-eighths inches long and weighs from three-fourths 
of an ounce to an ounce. The third month establishes the human 
form, but the head greatly predominates in size; the limbs have 
definite shape and imperfect nails are found upon the fingers 
and toes. During this month the external organs of generation 
become distinct, although they made their appearance several 



504 OBSTETRICS. 

weeks earlier. At the end of the period the fetus measures two 
and three-fourths inches in length and weighs about four ounces. 

Fourth month: Short hair appears on the scalp and other 
portions of the body. The eyelids, nostrils and lips are closed, 
the anus opens and the coil of intestines, which before extended 
into the umbilical cord, now lies within the abdominal cavity. 
The head forms about one-fourth of the entire body, and the 
bones of the skull, though hardening, are still widely separated. 
The sexual distinction in the external organs is well defined. 
At the end of this period the fetus weighs about seven and three- 
fourths ounces and is five inches in length. 

Fifth month : The heart, liver and head are unduly large ; 
the small intestines show traces of bile (a pale, yellowish green 
color) ; the lower extremities are longer than the arms ; the nails 
are well formed, and hair is plentiful but without color. At the 
end of this month the fetus is eight inches long and weighs a 
pound. Its movements are plainly felt by the mother. 

Sixth month : The surface of the fetal body is much 
wrinkled; the sebaceous coating, composed of oily secretion and 
epithelial scales, is beginning to appear, and protects the skin 
from the amniotic fluid; eyebrows and eyelashes are also appear- 
ing. The length of the fetus at the end of this month is twelve 
inches and its weight about two pounds. It is possible for 
children at six months to live, but they very seldom do. 

Seventh month : The subcutaneous fat makes the fetus 
appear somewhat plump; eyelids permanently open; the liver is 
comparatively large; meconium occupies the large intestine; the 
testicles have descended to points even with the inguinal canals. 
About half of the children born at this time live. The fetus is 
now fourteen inches long and weighs three pounds. 

Eighth month : There is increase in bulk rather than weight ; 
the skin becomes a brighter flesh color ; the scalp is supplied with 
hair; the nails almost reach the finger tips; the vernix caseosa 
forms a complete coating; the subcutaneous fat is increased. 
At the close of this month the fetus measures sixteen inches and 
weighs four to five pounds. 

Ninth month : At full term the fetus has a well rounded 
body ; the skin is less highly colored ; both testicles have descended 
into the scrotum, and in the female the greater labia are in con- 
tact; the intestinal tract contains the dark greenish meconium; 



OBSTETRICS. 505 

the navel is almost in the center of the body. The full-term fetus 
is twenty inches in length and weighs from six to seven pounds. 

(a) Young mothers have the smallest children, and mothers 
between thirty and thirty-five years the heaviest. 

(b) The weight of the child increases with the number of 
previous pregnancies, if all of the same sex, that is, the first 
child is usually smaller than the next. 

(c) The weight of the child increases with the weight and 
length of the mother. All causes adversely affecting the physical 
condition of either parent may exert an unfavorable influence 
on the vitality and development of the fetus. 



CHAPTER II. 

CHANGES IN THE MATERNAL ORGANISM CAUSED BY 
PREGNANCY. 

As soon as the impregnated ovum escapes from the oviduct 
into the uterus it is caught by folds of the mucous lining which, 
with the membrane formed from the ovum itself, surrounds the 
germ and furnishes protection and nourishment. During the 
first three months small blood vessels of the mucous membrane of 
the uterus, enlarged for the purpose, unite with similar vessels 
of the fetal membranes, and thus furnish proper nourishment; 
but after this time there is a special development of a small por- 
tion of the uterus, usually near its top, in which these vessels 
become enormously enlarged, and communicate with similar 
vessels in the fetal portion of the placenta, after which the entire 
blood supply comes from this source and the small capillaries 
over the other parts of the uterine membrane contract and close 
up. The maternal vessels of the placenta are supplied with twigs 
from the uterine artery and the placenta is drained by minute 
branches connecting with the larger uterine veins. 

The human placenta, as seen in the expulsion of the after- 
birth, is about eight inches in diameter and one and a fourth 
inches in thickness. 

The placental blood vessels are the two umbilical arteries 
and one umbilical vein which extend from the placenta through 
the umbilical (navel) cord and are continuous with the circu- 
latory system of the fetus. The umbilical cord is made up 
principally of these vessels and a peculiar substance known as 
the jelly of Wharton. It is usually about twenty-two inches in 
length and a half inch thick. The amniotic liquid secreted 
from the amniotic sac surrounding the fetus, sometimes called 
the bag of water, increases as the pregnancy advances until it 
may reach a quart in quantity. It preserves the fetus from harm 
and furnishes a liquid medium from which it may absorb the 
necessary fluid. 

506 



OBSTETRICS. 507 

The enlargement of the mucous membrane of the uterus, 
which takes place on the liberation of a ripe ovum from the 
ovary, is increased when impregnation occurs, but the greatest 
change is in the size of the uterus, which from the rigid and 
tense virgin organ, two and three-fourths inches long, one and 
three-fourths inches wide and one inch thick, is transformed at 
the close of gestation into a soft, pliable sac fifteen inches long, 
ten and three-eighths inches wide and nine and three-fourths 
thick; and from a weight in the virgin of one and a fourth 
ounces is increased to two pounds, with its capacity enlarged 
to about eight pints. 

The blood vessels of the vagina increase in size and there 
is thickening and softening of its mucous membrane and muscular 
tissues. The larger amount of blood gives the vagina a dark 
bluish color, which is one of the signs of probable pregnancy. 
The external generative organs are also much more developed 
and prominent, with an increase in the secretion of the sebaceous 
follicles and sweat glands of the labia. The joints of the pelvis 
and their cartilages are somewhat softened. The pelvic floor is 
increased from one to three and three-fourths inches at the 
end of pregnancy and the diameter of the outlet or distance 
from the front pelvic bone to the lower part of the spine is almost 
doubled, thus greatly facilitating delivery. 

The abdominal walls show the enormous distention by more 
or less conspicuous lines, known as the striae gravidarum, which 
are found in over ninety per cent of pregnant women. They 
are bluish at first but gradually disappear after labor, leaving only 
a white scar-like appearance. These lines may also occur wher- 
ever there is great stretching of the skin from tumors or dropsy, 
and are due to displacement and partial rupture of the con- 
nective tissue ot the deeper layers of the skin. They may also 
be seen on the buttocks, thighs and breasts. The navel is also 
affected by the abdominal contents, becoming less deep by the 
fifth month, effaced at the seventh and during the remaining 
months protuberant. 

The breasts, too, undergo change in preparation for func- 
tional activity. There is an increase in all the tissues of these 
glands. They begin to enlarge as early as the second month, 
but not much until the middle of pregnancy. The nipples share 
in the increase, becoming enlarged, sensitive and more erectile. 



508 ' OBSTETRICS. 

A dark areola surrounds each, and after the third month the 
breasts contain a thin fluid called the colostrum, which can be 
pressed out. 

The general changes of pregnancy depend upon the changes 
in the blood and in the functional modifications of the nervous sys- 
tem. The pregnant woman has to secure nourishment, breathe, se- 
crete and excrete for two — herself and her fetus. If these are 
carried on in a fairly normal way health is maintained, but if 
these changes are developed in excess, disorders complicating 
the pregnancy are produced. The composition of the blood is 
altered as well as increased in quantity. Its watery elements, 
white corpuscles and fibrin are increased; its albumin and red 
corpuscles diminished. Poor hygiene and surroundings greatly 
reduce its quality. The growing fetus, developing uterus, chang- 
ing pelvis and enlarging glands demand a large amount of material 
and necessarily drain the maternal system, especially at the close 
of pregnancy. 

The heart is almost uniformly enlarged, being one-fifth 
more in weight in the pregnant stage, and disturbances of the 
circulatory system are of frequent occurrence. Palpitation of 
the heart in the early months is purely sympathetic, but in the 
later ones is due to interference from the enlarged uterus. Other 
blood changes may be so serious as to cause great swelling 
of the feet and legs, and even of the thighs. There is enlarge- 
ment of the liver and spleen, the latter being due to its relation 
to the circulatory system; the thyroid gland is also increased 
in size. 

The respiration is somewhat embarrassed in the later months 
by the upward pressure of the diaphragm because of the enlarged 
uterus, and since more blood must be supplied, the pregnant 
woman has more to purify, and eliminates more carbonic acid 
with the lungs. In the earlier months she may have a sympa- 
thetic nervous cough. To provide nutrition for herself and 
increasing organs, and the fetus and its appendages, she must 
digest more food and form more blood, hence must increase the 
activity of both secretory and excretory organs. Few women 
escape nausea and vomiting and the capricious appetite during 
the earlier months of pregnancy; but later the digestion and 
appetite improve, giving opportunity to improve the nutrition. 

The pregnant woman gains in weight irrespective of the 



OBSTETRICS. 509 

increase from the uterus and fetus. The average increase is 
about fifteen pounds, which is uniform during the nine months 
notwithstanding the vomiting. This increase is stored up mate- 
rial to be used after delivery. The activity of the sebaceous 
glands, the sweat glands and hair follicles is also increased. 
Discolorations of the skin are numerous, being found upon the 
abdomen, the navel, the face and around the nipples. Owing 
to the drain by the fetus upon the elements of the blood there 
is delay in the union of broken bones. 

The urine is more abundant and of lower specific gravity, 
probably because of the increased amount of blood. There are 
also changes in its quality and traces of albumen are often found. 
Albuminuria exists in many cases, more common in the latter 
than in the first half of pregnancy. It is aggravated by tight lacing 
and heavy skirts ; also by diseases of the heart and lungs. So 
grave is the significance of albuminuria, the urine should be 
closely watched, particularly during the latter half of pregnancy. 
Proper treatment will relieve in the majority of cases and the 
disability may be entirely overcome. This belongs to the prov- 
ince of the physician to manage. 

The mental condition depends much upon the nutrition. 
Women who are naturally cheerful may become irritable and de- 
pressed at this time and even melancholic or insane, while others 
feel exhilarated and energetic, both physically and mentally. 

DL-yCJNOSIS OF PREGNANCY. 

The first symptom in many women is nausea and vomiting. 
This comes in the morning upon assuming an upright position, 
or may come after breakfast. It may occur a few days after 
conception, but usually not until the fourth or fifth week, and 
generally ends at the fourth month when the uterus begins to 
rise out of the pelvis. The morning sickness is a sympathetic 
disorder reflected from the uterus, and aggravated by unpalatable 
food, sexual excitement or emotional disturbances. There may 
be cravings for indigestible food or substances. Excessive flow 
of saliva is a frequent accompaniment, which may last longer than 
the nausea and vomiting. 

The second symptom is the stopping of the monthly sickness. 
This is so reliable that if to the date of the beginning of the last 
menstrual period 278 or 280 days be added, an approximate 



510 OBSTETRICS. 

estimate of the time of the coming delivery is obtained. The 
menstruation may not cease until the second month of pregnancy, 
but the preceding menstruation being much diminished in quan- 
tity would be a very good sign. So many things may cause 
stopping of the menses that this symptom, unless corroborated 
by other symptoms of pregnancy, cannot be considered positive. 

Third. The breasts are in immediate sympathy with the 
reproductive organs and there is, with the constant increase in 
size, frequently a sensation of weight or of pricking, the veins 
become enlarged and more visible, the nipples enlarge and fol- 
licles are found in the areolae. A secretion after the second month, 
upon pressure, is significant. Suppression of the milk in nursing 
women is a strong indication of another pregnancy. 

Fourth. Disturbances of the bladder are common because 
of its diminished capacity, due to the increased size and settling 
down of the uterus, so that there is frequent urination; and ina- 
bility to retain the urine may occur from coughing or sneezing 
when the bladder is distended. 

Fifth. The intrapelvic signs. These are : (a) A softening of 
the neck of the uterus; (b) the dark blue color of the vulva and 
vaginal mucous membrane (but this may come from congestion 
due to vaginal or uterine disease) ; (c) Hegar s sign, an enlarge- 
ment of the uterus in all directions ; (d) the position of the uterus 
in the first and second months is lower, but in the third month 
it begins to rise and tip forward. 

Sixth. Abdominal changes in size, shape and appearance, 
(a) During the first eight weeks there is some -Rattening of the 
abdomen, probably due to the descent of the uterus into the pelvis, 
dragging with it the bladder and depressing the navel. At the 
fourth month the uterus begins to rise for accommodation from 
the pelvic cavity, reaches the navel at six months, and touches 
the cartilage of the breastbone in eight and a half months. 
Later it begins to sink in the pelvis as the ligaments relax. These 
are changes that precede the coming delivery. The uterus is 
more symmetrical and contracts on being touched. There are 
changes in the color of the abdominal surface, markings due to 
stretching and brown lines. Fetal movement can generally be 
seen through the abdominal walls after the sixth month. 

Seventh. Ballotment is the perception of the return of a 
solid body in a liquid when given a push from some external 



OBSTETRICS. 511 

source. The physician practices vaginal ballotment, but abdom- 
inal ballotment may be secured by pressing lightly some portion of 
the abdominal wall and at the same time giving an impulse by 
tapping from the opposite side. The abdomen must not be over- 
distended, the fetus must not be too large and there must be 
sufficient amniotic fluid to get this sign. It is obtained only in 
the fifth, sixth and seventh months, but when secured is an abso- 
lute sign of pregnancy, for no other condition presents a solid 
body floating in a liquid ; but if not obtained it does not preclude 
the possibility of pregnancy, for many conditions prevent it from 
being distinctly felt. 

Eighth. Intermittent contractions of the uterus, continually 
kept up independently of the will and perceptible to touch when the 
hand rests upon the enlarged uterus for a short time. Other 
conditions resemble this, even an overdistended bladder. 

Ninth. Quickening felt by the mother as the result of fetal 
movements. These usually first occur about the middle of preg- 
nancy, but are uncertain. When felt by the physician, as they 
often are by the sixth month, they are a very reliable sign. The 
patient may think that she feels movements when she does not, 
the sensation being due to gas in the intestines, or some other 
cause, giving rise to what is known as false pregnancy. 

Tenth. Uterine sounds caused by movement of the mother's 
blood through the uterine blood vessels. It is heard after the 
fourth month, but is uncertain and varies in pitch, duration and 
location. Sounds may be heard when tumors are present. 

Eleventh. The fetal heart sound cannot, as a rule, be heard 
earlier than the fifth month. Later it usually becomes quite dis- 
tinct, but it may be feeble throughout the entire pregnancy. When 
the child is in the normal position this sound is best heard at a 
point on the left side of the abdomen, midway between the navel 
and the front spine of the hip bone. The average frequency 
of the pulsations of the fetal heart is 140 per minute. They may 
be less or more frequent, and the rate often varies temporarily. 
These sounds are heard earlier in a large fetus and, usually, earlier 
in males. 

Twelfth. It is often possible to detect the size, shape and 
position of the fetus by abdominal touch. 

Thirteenth. Mentally and emotionally women are somewhat 
changed during pregnancy. Usually they are irritable, fretful and 
changeable, though they may be buoyant and cheerful. 



512 OBSTETRICS. 

RELATIVE VALUE OF THE SIGNS OF PREGNANCY. 

First. The presumptive evidences of pregnancy are men- 
strual suppression; morning sickness; irritable bladder; mental 
and emotional phenomena. 

Second. The probable evidences are breast changes; bi- 
manual signs; abdominal changes in shape, size and color; also 
changes in shape, size, color and consistency of the neck of the 
uterus ; uterine murmurs and intermittent contractions. 

Third. Positive signs of pregnancy are the active move- 
ments of the fetus ; passive movements of the fetus ; and fetal heart 
sounds. 

MATERNAL IMPRESSIONS. 

There is a widely prevalent belief that impressions received 
during pregnancy will in some way mark or deform the child, and 
many instances are cited, but, as a matter of fact, in very many 
of the cases to which reference is made, the impressions would 
have to have been received either before or after the time at 
which they did occur, to have been able to cause the conditions 
attributed to them. It has always been a great pleasure to me 
when questioned on this subject to assure my patients that if 
maternal impressions ever do in any way mar a child they are 
certainly rare exceptions. 

What a deformed and distorted people we would be were each 
child as seriously affected as supposed, by every disagreeable shock 
received by the mother during pregnancy. At the same time it 
is wise to avoid undue emotions and unpleasant shocks and scenes, 
for they are sometimes the causes of miscarriage. 

As there is little doubt that the mental and physical inherit- 
ance of the child is the sum of both parents' attainments, natural 
and acquired, good and bad, how necessary not only that the 
mother lead an ideal life during the nine months, the father heart- 
ily assisting her, but that all their former months should have been 
just as well spent, that the child to be shall have that highest ad- 
vantage, a goodly heritage. 

THE DURATION OF PREGNANCY. 

The normal duration of pregnancy is nine calendar or about 
ten lunar months, or 270 to 280 days from the first day of the last 
recurring menstrual period. One of the best methods of comput- 



OBSTETRICS. 513 

ing the end of pregnancy is to determine the exact day on which 
the menstruation last appeared, count forward nine months or 
backward three months, and add seven days. 

There are many exceptions and, even were the circumstances 
such that there was but a single coitus, there is a difference 
of time in different women, and in the same women at different 
times, between insemination and the fertilization of the ovum. 

Y\ nile it is not positively known for how long a time the ovum 
is capable of fertilization, experiments upon the lower animals 
have justified the opinion that it is as long as it remains in the 
oviduct, or about eight days. The spermatozoa show remark- 
able vitality even under less favorable circumstances and may re- 
tain their function up to three weeks after being deposited in the 
vagina. These facts render it impossible to fix with any certainty 
the beginning of pregnancy — that is to determine positively the 
moment of fecundation. The length of pregnancy often becomes 
a serious question, affecting the moral character of the mother and 
the legitimate and hereditary rights of the child. The records 
of many obstetricians show numerous cases of prolonged preg- 
nancy. Since the development of certain portions of the body, 
as the teeth, are often delayed, we are forced to believe that 
gestation may be prolonged and delivery delayed. 

THE HYGIEXE AXD MANAGEMENT OF PREGNANCY. 

In order that the pregnant woman may be carried safely 
through this the most trying period of her life, attention must be 
given to diet, exercise, rest, sleep, clothing and bathing. To 
meet coming demands the breasts need preventive treatment. 
Early in pregnancy the desire for food is diminishd and there is 
craving for unnatural food. A fair amount of nourishment must 
always be taken. It should be easily digested and so prepared 
as to make it palatable. Attention must be paid to desire for food 
as far as possible, and associations made congenial. In this way 
the morning sickness may be much lessened. In the fourth month 
the stomach irritability usually ceases and the appetite increases. 
All foods, animal and vegetable, that are reasonably well digested 
are suitable to her needs. The diet must still be. simple, A T ery nu- 
tritious, easily digested and taken at regular intervals. It should 
include a good supply of nitrogenous food, such as eggs, milk and 
easily digested meats, and vegetables and fruits. A good supply 

33 



514 . OBSTETRICS. 

of nutritious food improves the blood, increases functional activity, 
prevents emotional and nervous irritability, and promotes the 
healthy growth of the fetus. 

No iron clad rules can be made as to just what any person 
should eat, but the pregnant woman must not eat a large amount 
of sweets and stimulants. Vegetables are good for her, but in- 
ferior to fruits. An abundance of water is a necessity. Milk, 
when it agrees, is a valuable addition to the diet, and sometimes 
is greatly needed. In cases of albuminuria, the milk diet, strictly 
enforced, will greatly lessen the danger of the complication known 
as eclampsia or the spasms of pregnancy. In the latter part of 
pregnancy the enlarged uterus so presses upon the stomach that 
the food must be taken in smaller quantities and more frequently. 

If the intestines become torpid, such laxatives should be used 
as will produce a free movement without purging. Compound 
licorice powder in small doses or mineral water, such as hunyadi, or 
a laxative, as cascara sagrada, five grains, or twenty drops of the 
fluid extract, is useful. When the liver is inactive, one-fourth 
grain of calomel and soda tablets are advised, to be repeated every 
half hour until four doses have been taken, then followed two hours 
later by a saline laxative, as a tablespoonful of Epsom salts, a tea- 
spoonful of phosphate of soda, or a Seidlitz powder. The pre- 
vention of constipation and toxemia requires such care of the skin 
as will promote its free action. Frequent bathing in tepid water, 
flannel, varying in weight according to the season and climate, 
worn next the skin, massage and gentle exercise, should not be 
neglected. The patient should have an abundance of fresh air, 
and, properly clothed, may be outdoors in all weather. 

With few exceptions, all can take moderate exercise, but vio- 
lent exercise and great fatigue should be avoided. There should 
be no riding over rough roads, or on horseback, or dancing or lift- 
ing heavy weights, and long journeys by land or water should not 
be taken. Without doubt women accustomed to active exercise, 
if no complications arise, have easier labors, but those not ac- 
customed to it should not then take more than they can com- 
fortably bear. For those who cannot take active exercise passive 
exercise is beneficial. Fresh air and sunlight should be obtained 
by riding in the open air. The pregnant woman should not live 
in crowded, ill-ventilated rooms. If there is much relaxation of the 
joints exercise may be objectionable; it always is when there are 
symptoms of miscarriage. 



OBSTETRICS. 515 

There must be plenty of sleep. A portion of each day, at least 
an hour or two after the midday meal, should be set aside for sleep 
or rest in the recumbent position. 

The clothing- should be so worn as not to compress the 
abdomen or chest and is best suspended from the shoulders. Cor- 
sets and tightly fitting skirts, by causing abnormal pressure upon 
the uterus and its contents, predispose to the complications of 
pregnancy, albuminuria and uremia. To women with relaxed ab- 
dominal walls a bandage which supports gives great relief. Every 
measure should be used to relieve pressure upon the renal and 
pelvic veins. 

Bathing should be kept up as in health, once a day in warm 
weather, and twice a week in cold weather, using plenty of soap 
and water, the temperature of the bath to be that which is most 
agreeable. If the activity of the skin is impeded in the later 
months of pregnancy the functional activity should be stimulated 
by frequent baths. Vaginal injections are not needed unless there 
is much leucorrhea, in which case a saturated solution of boric acid 
should be used from the fountain syringe with gentle flow. 

Sexual intercourse should be very carefully regulated, for it is 
often injurious to the pregnant woman, giving rise not only to 
much pelvic discomfort but being the primary cause of many 
abortions. This is especially true of the first and last months of 
pregnancy. If the neck of the uterus becomes diseased, re- 
quiring local treatment by the physician it may be safely given. 
Abortions are more likely to result from diseased conditions that 
have been neglected ; and many nervous complications, nausea and 
even greater dangers can often be avoided, and the delivery made 
easier, by careful local treatment. 

The mind should be pleasantly occupied, cheerful and agree- 
able associations provided, and plans of entertainment not neg- 
lected, since many of the former occupations are beyond reach. 
It is the time for the husband to intelligently co-operate with the 
wife. 

For disorders of the stomach koumiss sometimes gives good 
results. It may be necessary to resort to rectal feeding. Nausea 
and vomiting can often be relieved or made bearable by judicious 
treatment. There are many preparations for this purpose but 
they should be taken only when prescribed by the physician in 
charge. The bowels should be moved at least once daily. 



516 OBSTETRICS. 

In constipation a teaspoonful of phosphate of soda in a cup 
of hot water before breakfast, or a Seidlitz powder, as needed, may 
be used ; but cascara sagrada in five-grain tablets, or twenty drops 
of the fluid extract at bedtime, is a better remedy, in some cases. 

It is of still greater importance to examine the urine at least 
once a month during the last half of the pregnancy, for indications 
are often thus obtained whereby spasms and uremia may either 
be avoided or modified. 

The breasts need plenty of room for development. If the 
nipples are retracted they should be drawn out with the thumb 
and finger for a few minutes each day for the last six weeks. 
Daily washing with cold water is necessary. During the last 
month, to prevent sore nipples, bathe them in strong alum water, 
or a lotion made by adding a dram of tannic acid to a half ounce 
each of glycerin and water. Apply once every day. 

As the pregnant woman is subject to all kinds of disorders 
and her enfeebled system is rich soil for disease, anything added 
to the burden of maternity may become a most serious menace 
both to herself and child, and as no two women are alike in preg- 
nancy, and as no two pregnancies are alike in the same woman, 
the only safe way is to consult a good physician in case of ailments 
and complications. 

CONDITION OF THE UTERUS AND ITS APPENDAGES. 

The pregnant uterus naturally inclines to the right, and may 
sometimes so rotate as to seem almost twisted. Its great enlarge- 
ment favors the increase of any tumors that may be within its 
tissues or closely connected therewith. If small they may not be 
discovered, or they may be the cause of early abortion, or give 
rise later to bad results. Cancer increases very rapidly during preg- 
nancy and is a serious complication in labor. 

Inflammation of the mucous membrane of the uterus is 
often a cause of abortion, and of hemorrhages or watery discharges 
should the pregnancy continue. This condition is usually a result 
of an inflammation which existed before conception. It may give 
rise to adhesion of the afterbirth, also to intermittent fever from 
blood poisoning. The treatment in such cases would be the 
emptying and cleansing of the uterus under antiseptic precautions 
by the physician in charge. 

Inflammation of the oviducts often causes much pain during 



OBSTETRICS. 517 

pregnancy by reason of the exudation and adhesions which restrain 
the uterus from increasing easily and normally, and thus becomes 
a cause of abortion. It may give rise to general peritonitis and 
acute attacks of blood poisoning when labor occurs. A woman 
with this affection should avoid pregnancy. If it habitually exists 
a thorough course of treatment for recovery must be taken. 

Diseases of the ovaries are generally made worse by preg- 
nancy. 

The disorders of the vulva occurring during pregnancy are 
usually due to injuries or constitutional disturbances, but are some- 
times caused by lack of cleanliness, in which case local treatment 
should be applied. 

Pruritis, or itching of the vulva, is one of the most disagreeable 
complications and, when not due to lack of cleanliness, is usually 
a result of digestive troubles or diabetes, though it may arise from 
some local cause. It is besi treated by frequent baths followed 
by applications of soothing ointments, of which carbolic oint- 
ment and carbolized vaseline salve are good. The disorder may 
also require constitutional remedies. 

Displacement of the uterus may cause great discomfort, com- 
plicating and even terminating pregnancy. Weakened uterine 
supports often follow frequent pregnancies and allow displace- 
ments to occur. The most frequent form is the retroverted uterus, 
that is, the body of the uterus is tipped back upon the rectum, 
causing a dragging sensation with a probability of impaction in 
the pelvis. Relief is obtained by lying upon the side or resting 
upon the chest and knees. When there are no adhesions and 
still no tendency to right itself, manipulation by the physician will 
often succeed. Sometimes it is necessary to retain the uterus in 
the proper position by wool pledgets, or a properly fitting pes- 
sary, until the fourth or fifth month, when the uterus rises above 
the pelvis and further danger from this source is removed. Cases 
of habitual abortion may be cured by thus raising the uterus. 

When there are adhesions great care must be given to stretch- 
ing them gradually by the use of cotton or wool tampons. It 
must be borne in mind that where adhesions exist there is also a 
possibility of inflammation that may give rise to blood poisoning. 

The urethra, bladder and ureters have an increased blood sup- 
ply during pregnancy and thus share in the disorders. The 
urethra may be closed in some portion by pressure of the displaced 



518 OBSTETRICS. 

uterus, and great distention of the bladder result with paralysis 
of its muscular layer and decomposition of the urine, followed 
by erosion, ulceration and, finally, perforation, unless relieved by 
the catheter. 

COMPLICATIONS DURING PREGNANCY. 

If inflammation of the bladder or bloody urine occurs during 
pregnancy, rest in bed is necessary. If there be gonorrheal in- 
flammation of the urethra, careful treatment must be given, for 
when labor comes pressure upon the urethra may liberate germs 
that until that time had been quiet and an inflammation of the 
bladder follow which may extend to the ureters and kidneys, giv- 
ing rise to acute inflammation of the kidneys. This process 
reaches its development only after several weeks, and the patient 
usually dies from blood poisoning. 

The kidneys share with the other organs in the general 
congestion and enlargement at this time, and their diseases are 
aggravated by the pregnancy. This congestion is due to the 
tension to which all the organs within the abdominal cavity are 
now subjected, to disturbances in the nutrition of the kidneys 
because of the altered condition of the blood, and to engorgement 
of the ureters from mechanical pressure. Convulsions may occur 
without kidney trouble, but in most cases a diseased condition of 
the kidneys is easily shown. In acute kidney failure there is 
a great diminution in the amount of urea excreted and this means 
a quick fatality unless the condition can be remedied. The albumi- 
nuria of pregnancy is of very frequent occurrence and is not of ser- 
ious import unless due to kidney inflammation — a matter which 
can be decided by a microscopical examination of the urine. 

The treatment of the disorders of the urinary organs in- 
volves an examination of the position of the uterus with relation 
to the bladder and ureters, and correction of all displacements, also 
examination for inflammation of the bladder, which disease may be 
treated by a douche of some antiseptic solution. There is danger 
that after labor a case of chronic Bright's disease may set in. 

Peritonitis during pregnancy is usually the result of previous 
inflammation, from germs or spores, of the mucous membrane of 
the uterus, of the oviducts, or of the connective tissue of the 
pelvis, A sudden exposure to cold or dampness, or a cold bath 
when the patient is overheated, may give rise to a fatal peritonitis. 
It may also be caused by mechanical injury or severe strain. 



OBSTETRICS. 519 

Concealed hemorrhage into the abdomen, or into the uterus, 
during the last months of pregnancy is of serious import. It is 
best recognized by the collapse and general condition of the pa- 
tient. Treatment must be applied very quickly. 

A relaxation of the pelvic ligaments often occurs, sometimes 
so great as to cause lameness and considerable pain. An ab- 
dominal bandage, having padded perineal bands, is the most suc- 
cessful treatment. 

In the changes during pregnancy there is often formed and 
carried into the blood a toxic material which may endanger the 
life of mother and child. The principle form of this poison is an 
animal alkaloid known as a toxine. The symptoms produced by it 
are chiefly of a nervous variety. Several poisonous principles 
have been found in the urine. Poisons absorbed from the intes- 
tines are closely related to the toxines of pregnancy, and this is 
more likely to occur when, from displacement, the uterus presses 
upon the rectum. It has been noted that in such cases there is 
very little if any structural change in the kidneys. This trouble 
during pregnancy has been ascribed to the inactivity of the liver. 
The treatment is preventive by keeping the secretions up to the 
normal amount. 

All compression of the pelvic organs should be avoided by 
wearing loose clothing suspended from the shoulders. The corset 
should be abandoned. Constriction of the blood vessels should 
also be avoided by guarding against constipation, and by wearing 
loose shoes and no garters that encircle the legs. To prevent con- 
stipation the patient must partake only moderately of heavy meats. 
Abundance of fruits, cooked or raw, and, if the digestion is good, 
whole wheat, graham and rye bread are proper. 

Women may pass through pregnancy without serious trouble, 
but again may not, and as many grave complications may be 
avoided by the timely use of preventives, none can afford to be 
negligent. Vigilance is the price of safety, even though it cost 
much inconvenience. The amount of urine should be observed and 
if there be any decrease the physician should be notified. 

The amount and character of the excretions and the condi- 
tion of the nervous system are two things of great importance in 
the diagnosis of toxemia. Its treatment consists of prompt stim- 
ulation of all the excretory organs. 

When threatened with toxemia the diet should consist of milk, 



520 OBSTETRICS. 

fruit and bread, or fish, oysters and gruel. Avoid meat, eggs, 
vegetables, pastries of all kinds and stimulants, including tea and 
coffee. The examination of the urine should note the quantity 
passed daily and the amount of urea. If there is inflammation of 
any importance the microscope will show granular casts. 

Simple albuminuria is of little importance, but the circula- 
tion of poisonous materials in the blood of the mother calls for 
most urgent treatment. 

DISORDERS OF THE NERVOUS SYSTEM. 

Often the neuralgias are of great annoyance. They have their 
starting point in some disordered condition of the nervous system, 
or irritation from decayed teeth. If there is very much constipa- 
tion and the fetus is large so as to press heavily on the pelvis, there 
may even be sciatic pain and obstinate cramps in the limbs, causing 
great distress. If caused by a misplaced uterus that should be 
remedied, and attention then be given the bowels, and the 
large bowel thoroughly flushed and emptied. Anemia and 
malaria are also causes of neuralgia; the relief of the former con- 
sists of building up the entire system; for the latter, antimalarial 
remedies are in order. Neuralgias come at irregular times, some 
at night, others in the morning or afternoon and attacks follow ex- 
posure to dampness and cold. If painful spots can be located, 
they may be painted with iodine or rendered insensible by an 
ether spray. The constitutional treatment consists of freely 
emptying the bowels that the system may be cleared of the poison 
of retained feces, that may be depressing the nervous system. 
Sometimes absolute rest in a warm, room is necessary. Besides 
simple, easily digested food, tonics may be useful. 

Derangement of the various secretory nerves during gestation 
is seen in what is called the salivation of pregnancy, and the exces- 
sive secretion of tears and perspiration in poorly nourished women. 
Herpes is another of the annoyances. It usually occurs about the 
fifth month and is apt to recur in succeeding pregnancies. Al- 
though an intense itching accompanies the eruption, the pregnancy 
is in no way affected by it, the general health remaining good. 
It may also come after labor. The treatment consists in regulat- 
ing the bowels and other functions of the body.. The hypophos- 
phites and iron are valuable in these cases. Local applications 
to be made are borated vaseline, or lime water and olive oil. When 



OBSTETRICS. 521 

the eruption has fully developed subnitrate of bismuth or powdered 
starch are soothing and useful. For the itching, carbolic acid in 
diluted solution, or menthol, is effective. When a large part of the 
body is involved, baths containing starch or bran are very grateful. 
Universal pruritis may materially interfere with the patient's gen- 
eral health. 

Mania during pregnancy is seen in those women who are of a 
very nervous disposition, or who have inherited insanity. Alco- 
holism and hysteria predispose to it, and it may be caused by great 
mental shocks at this time. 

Unhappy marriage is also an important factor in the causation 
of the insanity of pregnancy. Toxemia may also be a cause, as as- 
certained by examining the excretions. The prospect for recovery 
depends upon the cause and whether it is removable or not. If 
mania follows a severe shock and if the patient's general health 
is good, the outlook is encouraging ; but if there is great physical 
disability, founded upon some diseased condition, 'the aspect is 
most serious. The treatment consists in the use of sedatives, 
complete seclusion from all company and a building up of the gen- 
eral health by every available means. When due to toxemia se- 
datives should not be given, but remedies used to promptly elimi- 
nate the poisons from the system. 

THE NAUSEA AND VOMITING OF PREGNANCY. 

The nausea and vomiting of pregnancy may be ascribed to 
some derangement of the uterus, such as malformation or dis- 
placement, or an injury to this or some other of the genital organs, 
sudden shock, disease affecting the blood, movements of the fetus, 
or violent peristalsis of the intestines. Distention of the bladder 
and rectum is frequently present. An inherited tendency to ner- 
vous irritability is often a predisposing cause. 

The vomiting usually comes early in the morning, just as the 
patient lifts her head from the pillow, and is almost instantaneous. 
It may be repeated, and is without straining. After this the pa- 
tient may take food and no more trouble occur until the next morn- 
ing. The more severe cases begin in the morning and are not re- 
lieved by vomiting. The materials ejected are mucus, burning, 
bitter, and often sour. Although food may be taken and retained, 
the nausea may persist until late in the day, or longer. Distress 
of anv kind, or certain articles of food, may increase it, and if the 



522 OBSTETRICS. 

vomiting is repeated there is likely to be straining and retching. 
After midday the patient is likely to be much better and able to eat 
a full meal. 

In another class of cases the nausea is persistent, continuing 
through the waking hours. Various articles of food are craved 
but give no .satisfaction. There is much vomiting and retching, 
with either dryness of the mouth and throat, or salivation. The 
vomit may first be mucus and food, then bile, and in more severe 
cases blood, then a coffee-grounds material. Food is no sooner 
taken than ejected; yet there are times of tolerance which give op- 
portunity for some nourishment. Later in the case there is dis- 
tress beneath the breast bone ; emaciation is more or less rapid ; a 
clammy sweat appears and there is great anemia. The signs of 
improvement are less vomiting and nausea, ability to retain food, 
natural excretions and considerable periods of sleep without vom- 
iting. 

It is hard to relieve cases of nausea and vomiting when the 
pregnant uterus is tipped back and bound down in the pelvis. This 
condition may be caused by persistently wearing tight clothing 
before and after the beginning of pregnancy, or it may be con- 
genital. In order to properly treat this malady a thorough ex- 
amination of all external causes, as well as a knowledge of the 
uterine condition, is necessary. When there is displacement, re- 
place if possible. The uterus is often retained in proper position 
by tampons of wool inserted by the physician. 

In serious cases of vomiting the treatment consists of 
putting the patient to bed, in the care, of a competent attendant 
who will secure nourishment by supplying a variety of foods, 
and conserve the strength so much needed. The nourishment 
should be given by mouth if possible; if not, rectal feeding must 
be the next resort. The articles best given are beef in the form 
of peptonoids, peptonized beef juice, peptonized milk, champagne 
by stomach, and alcohol by rectum when necessary. 

In case of chronic catarrh of the stomach the stomach may 
be washed out with salt and water, a teaspoonful to the quart, 
by means of a stomach tube. Solid food must not be given 
until there is considerable improvement ; the patient's taste 
may be used as a guide. When only digestible articles are 
allowed, scraped raw beef, oysters, junket, milk with lime water 
and broths may be taken. A warm bath will often secure rest 



OBSTETRICS. 523 

and stimulants can be given by the rectum when necessary. 
Spontaneous cure of this trouble is no doubt due to a misplaced 
uterus righting itself by some change of position. 

Bad conditions of the mouth and teeth often cause much dis- 
tress. The gums may become very soft. The pain in the teeth is 
sometimes a reflex from the uterus. The treatment lies in proper 
attention to the general health. The decayed teeth should be 
filled with as little irritation to the patient as possible, or, if neces- 
sary, extracted rather than allow continued suffering. 

The blood is frequently bad in ill-nourished women. The 
anemia of pregnancy should be treated by tonics and proper diet. 
Unless these women are built up in general health, alarming 
symptoms frequently develop as the pregnancy advances and the 
diseased conditions of the blood become more pronounced. 

During the last months of pregnancy pressure upon the rec- 
tum predisposes to piles. They are relieved by hot compresses, 
or by an ice bag if more agreeable to the patient. Witch hazel 
on cotton and equal parts of belladonna and stramonium oint- 
ments are also efficient remedies. 

INFECTIOUS DISEASES DURING PREGNANCY. 

Pregnancy renders the patient peculiarly liable to the devel- 
opment of infectious germs, the excessive blood supply being 
favorable to their growth, so that complications of such a nature 
at this time assume very severe forms. Gonorrhea is frequent. 
When there is burning and difficulty in urination, with an irri- 
tant discharge, there should be an examination for this disease, 
although other causes exist for these symptoms. The attack is 
more virulent than in the nonpregnant, and the gonococci may 
not only infect the mucous membrane of the vagina, rectum and 
surrounding tissues, but also that of the uterus and the fetus itself. 
Children have been born with gonorrheal ophthalmia. The 
mother's entire genital tract may be affected, including ovaries 
and tubes. It does not always immediately show itself, but after 
labor may sometimes be the cause of death through virulent 
blood poisoning. In every locality of the body affected strong 
antiseptic measures must be adopted when it can be reached, or, 
in extremity, surgery employed. 

Syphilitic infection may run the ordinary course or may 
become very malignant. Septic germs may be associated with 



524 OBSTETRICS. 

syphilis and give rise to blood poisoning after labor. Syphilis 
predisposes to abortion and in 75 per cent of the cases the fetus 
is lost. The disease is aggravated by pregnancy. To be effi- 
cient anti-syphilitic treatment should begin as soon as infection 
occurs. 

The local treatment consists of cleanliness and the mainte- 
nance of local asepsis. Antiseptic douches should be used to 
cleanse the parts, and ulcers should be dusted with calomel and 
iodoform. All discharges of such patients must be received in 
absorbent cotton and burned. The constitutional treatment be- 
longs to the physician to direct. In addition it is of great im- 
portance that a liberal diet with stimulating tonics be persist- 
ently taken. Since the condition of the pregnant woman renders 
her so liable to contract contagious and infectious diseases, she 
should not be exposed to scarlet fever, measles, diphtheria, ery- 
sipelas, small-pox, varioloid, cholera or whooping cough, or live 
in rooms where a consumptive is confined. The danger is es- 
pecially great when exposure to any contagion or infection occurs 
either during labor or in the lying-in period. 



CHAPTER III. 



ABORTION. 



The term abortion is generally applied to the termination 
of pregnancy, by the expulsion of the ovum, before the expiration 
of twenty-eight weeks ; expulsion of the fetus after that, and until 
a short time before full term, being called premature delivery 
or miscarriage. Abortion occurs most frequently in the first 
three months of pregnancy, when the ovum is usually expelled 
intact; the greater liability at this time being due to the greater 
vascularity of the uterine mucous membrane, the feeble attach- 
ment of fetal membranes, and, in the third month, to the change 
from the complete attachment of the ovum to the uterus to 
the partial attachment at the site of the placenta. Later the 
placental attachment becomes stronger and the uterus adjusts 
itself to the new order of things. 

Abortion is caused by fetal death or uterine contractions, 
and may be referable to the father, mother or fetus. Exciting 
causes, when combined with predisposing causes, act more di- 
rectly upon the ovum. They are violent coitus, blows, falls, 
contusions, jars of railroad traveling, long rides, rapid stair 
climbing, lifting heavy weights, running a sewing machine, sea 
bathing, stretching the arms above the head, missteps, etc. 
Many of the predisposing causes become effective only when 
joined with some exciting cause. It is impossible to predict in any 
case that an abortion will occur under certain circumstances, 
for often a very slight cause is sufficient, then again most serious 
accidents have occurred and the pregnancy remained undisturbed. 

The paternal causes of abortion are syphilis, extreme youth 
or old age, debauchery and feebleness. The maternal causes are 
syphilis, tuberculosis, infectious diseases, disorders of the kid- 
neys, lungs, liver and heart, excess of carbonic acid, convulsive 
diseases, excessive vomiting or coughing, chronic lead poisoning, 
great physical exertion, fright, anxiety and other emotional ex- 
citement. The habit of abortion is probably due to a continu- 

525 



520 OBSTETRICS. 

ance of the conditions which first led to it, and the prospects of 
escape from it in future pregnancies depend upon the probability 
of relief from these conditions. 

Local causes are chronic or acute inflammations of the uterus 
and its appendages, tumors, adhesions and displacement. Retro- 
flexion and endometritis are especially liable to give rise to uterine 
contractions. Attachment of the uterus to other organs, a con- 
tracted pelvis and tight lacing may cause fetal death by prevent- 
ing the development of the uterus. Surgical operations upon dis- 
tant parts have caused abortion; again very serious operations 
have been performed upon the pelvic organs without causing any 
trouble, but in such cases there is always danger. 

The fetal causes of abortion are any abnormal condition of 
the ovum or its appendages, which may produce death of the 
fetus; as inflammation of the membranes, syphilis, placental ap- 
oplexy, abnormal positions of the placenta, especially when near 
the mouth of the uterus, too short a cord and knotting of the 
cord. 

The death of the fetus may be caused by disease transmitted 
by the mother, such as syphilis, small-pox and other infectious 
diseases. The symptoms indicating abortion are seldom to be 
depended upon before the third month of pregnancy and cannot 
always be relied upon after that time. 

Some of the signs are shifting pains in the back and abdo- 
men, frequent urination, nausea and vomiting, and if with these 
there be a watery discharge from the uterus the probability of an 
abortion should be considered and preventive treatment com- 
menced. An abortion is generally slower than a normal labor. 
Its duration depends upon the cause, the conditions present and 
the frequency and energy of the contractions of the uterus. 
If caused by a shock or severe fall an abortion may be almost in- 
stantaneous, or after a few gushes of blood, but this is not the rule. 

In early abortion hemorrhage is usually the first symptom. 
It is often excessive and may be sufficient to cause the death of 
the mother. It may precede pain for hours, days or even weeks; 
or it may be accompanied by pain, but rarely so in the beginning. 
The hemorrhage may be slight at first and increase or decrease, 
or stop entirely, to begin again upon some excitation. The blood 
may ooze continually from the uterine surface and collect in con- 
siderable quantities to be expelled in clots. The amount of blood 



OBSTETRICS. 527 

lost varies with the time in the pregnancy, being less near its com- 
pletion, also with the extent of injured surface caused by the sepa- 
ration of the ovum from the uterine walls. The bleeding usually 
continues until the uterus is emptied. 

The pains of abortion resemble labor pains, and vary accord- 
ing to the existing conditions. In rare cases pain may precede 
the hemorrhage and is then likely to be harder to bear than the 
usual labor pains. 

In the expulsion of the uterine contents, instead of the pla- 
centa and membranes being expelled with the fetus, a portion or 
all of the placenta or membranes may remain in the uterus and 
there be considerable delay, even days, weeks or months, before all 
is expelled. As long as any portion of the ovum or membranes 
remain in the uterus the patient is liable to hemorrhage and blood 
poisoning. When abortion has taken place, and is supposed by 
the patient to have been completed, it is very essential that all 
fragments of tissue and the ovum, or supposed ovum, be saved for 
inspection by the family physician, since positive diagnosis from 
their examination will enable her to avert future risks and to de- 
termine upon the best modes of procedure. 

A threatened abortion may be averted by proper measures, 
the first of which is absolute rest in bed, even in the mildest cases, 
and the next the care of the physician. During pregnancy even a 
slight show of blood requires this quiet rest in bed, as almost in- 
variably matters go from bad to worse and, since in this condi- 
tion, the life, both of mother and child, is at- stake, no woman 
should take any risks. For the child, in the earlier months, death 
is certain, while to the mother a badly managed case of abortion, 
with the resultant pernicious consequences, is not nearly as amen- 
able to treatment as the same condition after labor at full term. 
There may be anemia with great debility after severe hemorrhage 
at the time of the abortion, or recurring hemorrhages may re- 
sult from the failure of the uterus to return to its normal size, 
or from retained fetal membranes. 

Some of the common local results of abortion are inflamma- 
tory diseases of the uterus, ovaries, tubes and adjacent structures, 
which may lead to abscesses. If some of the membrane or pla- 
centa be left, moles or tumors of the uterus may be formed; or 
there may be secondary infection, resulting in abscesses in the 
joints or any other part of the body. Abortion is disastrous also 



528 OBSTETRICS. 

to the nervous system, the irritation often being due to reflex 
manifestations arising from local conditions, or to self-infection 
from a continuous absorption of slightly poisonous materials 
from a chronically inflamed mucous membrane. 

The preventive treatment in abortion consists of making the 
patient as nearly perfect physically as possible, and from the be- 
ginning- of pregnancy carefully avoiding exciting causes. Local 
causes, such as tumors, uterine inflammations and displacement, 
should be treated and cured before conception, and general dis- 
eases, as tuberculosis, syphilis, anemia and nervous troubles, as 
well as chest and abdominal affections, remedied as far as possible. 

Syphilis is responsible for a greater number of. abortions than 
any other one disease. If present in one or both parents it should 
receive prompt and thorough treatment, and during pregnancy 
the greatest care should be taken to avoid all possible sources of 
irritation, as fatiguing work, lifting, riding, dancing, too long 
walks, stair-climbing, reaching, jumping, sea-bathing, corsets, 
tight clothes, contagious diseases, overheated or poorly ventilated 
rooms, crowded theaters or congregations, emotional excitement, 
late hours, etc. The diet should be carefully selected that acute 
indigestion, gas, nausea, colic, diarrhea and constipation may be 
avoided. The kidneys should be properly regulated, and coitus 
prohibited. At the time corresponding to the menstrual period 
the patient should spend several days in bed. In cases of repeated 
abortion it is wise to take from six months to a year for treatment 
of causative conditions before entering upon another pregnancy. 
In a few cases confinement to the bed, practically during the whole 
pregnancy, seems the only way of prolonging it to full term. 

In the beginning of an abortion, if the pains are not too 
hard or the hemorrhages too severe, there is hope, with quiet and 
rest, of preventing a further separation of the ovum from the 
uterus. The patient should be put to bed in the most quiet, best 
ventilated room in the house, and should remain in a recumbent 
position for several days, not rising even to a sitting position for 
any purpose, a bed-pan being used for defecation and urination. 

There should be no talking, or visitors, or worry of any 
kind. A free movement of the bowels must be secured each day 
by a mild laxative or rectal injection. The clothing must be cool 
and light, and the diet nutritious and easily digested, but not stim- 
ulating. All drugs and local treatment should be administered 
under the direction of a physician. 



OBSTETRICS. 529 

In the after management of abortion there should be given 
as much time for the repair of uterine lesion, and for the return of 
the uterus approximately to its former size, as in delivery at full 
term, and, owing to the imperfect development of the uterus at the 
time of abortion, even a longer period is often required for restor- 
ation. The treatment is quiet rest in bed, and such medicines and 
local applications as may be needed. 

The province of this book is to point out the dangers and 
show how to avoid them, and, since to be forewarned is to be 
forearmed and prevention is better than cure, the value of its 
counsel cannot be overestimated. Many times, too, it is able to 
name the remedies that will aid in the restoration to health ; but so 
many combinations of complications occur in abortion as to make 
each patient a law unto herself, and it is only upon careful diag- 
nosis by a skillful physician that treatment can be minutely pre- 
scribed; however, it is safe to say there would be a great de- 
crease in the number of pelvic disorders, and in the number of 
abortions as well, were women always treated after abortion as 
after normal labor. 

The fetus may die and remain in the uterus for weeks and 
months. This is called missed abortion. The symptoms of preg- 
nancy then cease, the waters are absorbed, the abdomen becomes 
smaller and milk appears in the breasts. The child in the uterus, 
with the placenta and membranes, may become macerated or 
mummified. It may not become putrid if the membranes are 
unbroken, for the air with its load of poisonous germs cannot 
then gain access, but when air does find an entrance suppuration 
with its attendant ills soon follows. A dead fetus in the uterus, 
even if it does not suppurate, impairs the general health and is 
always a source of danger, hence, after waiting a reasonable time, 
should be removed. 

EXTRAUTERINE PREGNANCY. 

Extrauterine pregnancy is the name given to a pregnancy oc- 
curring outside of the uterus, and although of sufficient importance 
and interest to require mention here, let no woman, because of 
having read this chapter, be frightened into believing that every 
strange sensation which she may hereafter experience is due to 
such a pregnancy, for the condition is rare. When it does occur, 
it may be either tubal, ovarian or abdominal. 

34 



530 OBSTETRICS. 

The tubal pregnane}' is the most frequent, and the abdom- 
inal form is probably due to a rupture of the tubal variety. The 
development of an ovum within a Fallopian tube is like that within 
the uterus, except that the tube, not being fitted for continuous en- 
largement, sooner or later ruptures beneath the broad ligament or 
into the abdominal cavity, at which time there is great danger of 
excessive internal hemorrhage with collapse and sudden death. 
The primary cause of extrauterine pregnancy is inflammation 
of the Fallopian tubes, following uterine inflammations. The time 
of the rupture depends upon the location. It usually comes from 
the second to the fourteenth week and, if there be no accident at 
the time of the first rupture, a second one may occur at any time 
up to full term. 

If, at the end of the second month of extrauterine pregnancy, 
the death of the fetus occurs it may be entirely absorbed ; if after 
that time, it either undergoes mummification, or calcification, or 
is converted into ammoniacal fat, or is decomposed. The mum- 
mified fetus resembles an Egyptian mummy, and may turn into 
stone, and remain indefinitely in the abdomen without causing dis- 
comfort. In case of rupture of the sac, so that air gains admit- 
tance from the intestinal canal or other source, decomposition sets 
in and an abscess may empty into the rectum, bladder or vagina, 
or even burst through the abdominal walls and with the pus dis- 
charge the fetal bones. Should the fetus live until full term it 
could be delivered only by an opening through the abdominal 
walls. It is often feeble and after the delivery is not likely to live. 

The treatment usually consists in removal of the fetus by an 
abdominal operation in order to save the mother's life, and this 
must often be done hastily to prevent death from hemorrhage — a 
crisis that may occur at any time during the pregnancy. 

The symptoms of an extrauterine pregnancy may not differ 
from those of a natural one, although at times the patient may 
be entirely unconscious of her condition. The breast changes, the 
disturbances of the stomach and pain in the affected side, with 
absence of menstruation, are the most frequent signs. There may, 
however, be an increase of menstrual flow with discharge of small 
pieces of membrane. Pain may be almost constant, or entirely 
absent and the patient may or may not consider herself pregnant. 
If a vaginal examination is made before rupture the Fallopian 
tube on that side will be found enlarged and, if the pregnancy is 



OBSTETRICS. 531 

much advanced, the uterus will be pushed to one side. There 
may be pressure symptoms, but any tumor would cause such a 
disturbance. 

The symptoms of rupture are very marked. The patient, 
usually well, or the subject either of but slight discomforts or of 
those attending pregnancy, is suddenly seized with severe abdom- 
inal pain. The attack may come after only slight exertion, or even 
when the patient is asleep in bed. If the hemorrhage is extensive 
extreme collapse and unconsciousness occur. If the rupture is into 
the broad ligament the hemorrhage may cease, to recur later. 
The pulse, at first rapid, becomes weak and imperceptible; the 
breathing quickened and jerky. This condition terminates in 
profound shock and, if the bleeding be not soon stopped, in death. 
The case calls for a rapid, skillful surgical operation. 

If the tube ruptures early into the broad ligament, and the 
fetus dies, there is usually no further trouble. Sometimes, in case 
of slight hemorrhage, with the first rupture, the fetus continues to 
grow until full term, provided a second hemorrhage does not re- 
sult disastrously, when there is an attempt at labor pains and 
feeble contractions. Prominent symptoms of pregnancy are al- 
ways present in the later months and at full term the fetus soon 
dies, after which the fluids are absorbed, the abdomen lessens in 
size and the fetus, as before explained, may remain intact, resem- 
bling a tumor, or change into a mummy or stone. There is danger 
of decomposition and blood poisoning for months and years after 
the death of the fetus, unless mummification or petrification does 
take place. These cases are very rare and when they do occur it 
is usually after several children have been born, and there has been 
a long interval following the last birth, or after an attack of pelvic 
inflammation. 

A tumor or an enlarged uterus tipped backward sometimes 
resembles an early pregnancy, both in size and symptoms, and 
unless life is in danger from inflammation or blood poisoning, the 
plan of waiting until positive signs of pregnancy appear is 
always in order. 

DISEASES OF THE FETUS. 

The fetus during its life in the uterus is protected from injury 
and disease by the bony pelvis, uterine walls and the bag of waters; 
but on the other hand is subject to the diseases of the mother and 



532 OBSTETRICS, 

father, nervous disturbances, high temperature, bad nutrition, 
diseases of the uterus and its appendages, and infectious diseases, 
all of which exert their influence upon its growth and develop- 
ment and may cause its death before birth. 

Certain tendencies to disease are inherited, such as unnatural 
conditions of the nervous system and lack of nutrition, drunken- 
ness, epilepsy, diabetes, consumption and cancer of either parent, 
and act unfavorably upon the development of the child and may 
cause its death in the uterus. 

If the mother suffers from an infectious disease, the fetus 
will be affected, either indirectly from an impaired nutrition, or 
from a direct transmission of the disease itself. In either case 
the pregnancy may be interrupted, or the child may die soon 
after birth. 

Infections of the mother do not all appear to be equally 
severe. La grippe, cholera, diphtheria, typhoid and serious cases 
of malarial fever are usually attended by miscarriage or prema- 
ture delivery, in many of which cases the fetus first dies of the 
disease, transmitted by the mother. The eruptive fevers are espe- 
cially likely to affect the child before birth and to cause miscar- 
riage. There are a good many instances of children being born 
with scarlet fever and measles. 

In about fifty per cent of the cases of pregnancy, complicated 
by small-pox, abortion occurs. Erysipelas usually interrupts preg- 
nancy. When the mother has consumption the child is generally 
puny, feeble and predisposed to lung trouble. 

The most fatal disease which affects the child in the 
uterus is syphilis. It may be transmitted by either parent. 
If the mother becomes infected during the last month of preg- 
nancy the child may escape, unless infected at birth or while nurs- 
ing. The earlier in the pregnancy the mother is affected the 
more likely is the fetus to die. In the untreated cases in which 
the infection occurs during the first three months the fetal mor- 
tality w 7 ithin the first few days after delivery is ioo per cent. The 
chances are little better if the infection occurs during the fourth 
and fifth months. As a rule infection of the mother is safer for the 
fetus than infection of the father. All modern authorities assert 
their belief that syphilis may be transmitted to the ovum through 
the spermatozoa without infecting the mother. 

The infection of the child may be taken for granted if either 



OBSTETRICS. 533 

parent acquired syphilis shortly before or after conception. The 
more recently the father has suffered from the disease the more 
likely is he to transmit it in a severe form. Often the child is pre- 
maturely born, with traces of the disease. In other cases it is 
apparently healthy at birth, but symptoms of the disease appear 
m from two to six weeks. There is usually marked general de- 
bility. Among the first symptoms of hereditary syphilis is snuf- 
fles. This is followed by a rash with red patches about the geni- 
tals, thighs and forehead. The upper lip is likely to be sore and 
cracked, and there may be inflammation and even ulceration of the 
mucous membrane of the throat, giving rise to hoarseness. The 
nasal catarrh may result in loss of the nasal bones. The child is 
likely to suffer from broncho-pneumonia. The liver is much in- 
creased in size and may be filled with hard nodules or spots of in- 
flammation. These children are also subject to severe hemorrhage 
under the skin, in the internal organs and from the navel. Ten- 
derness and swelling of the long bones is also symptomatic. 

The treatment of fetal syphilis is mainly in the use of pre- 
ventives. The parents may eradicate the disease by long-con- 
tinued treatment. The child is greatly benefited by treatment of 
the mother during the pregnancy, and, if it be continued faithfully 
throughout the entire term, there is a possibility of immunity for 
the child, otherwise its chances will be very slight. Mercurv 
and iodide of potassium are the most reliable remedies. 

MANAGEMENT OF THE FETUS. 

To properly manage delivery at full term it is necessary to 
study the health and habits of the patient during pregnancy and 
to know the history of previous labors; thus it is better that the 
pregnant woman should be under the care of the physician from 
the earliest days of gestation, especially if it be her first. In the 
last month an examination should be made to ascertain the posi- 
tion and presentation of the fetus and whether any complications 
exist, also to learn the relative size of the pelvis of the mother 
and the head of the child. 

It is usually possible, by external examination of the abdo- 
men, to determine the position of the child, whether its back is on 
the right or left side of the abdomen, or if, as sometimes happens, 
when the. abdominal walls are much relaxed, it is lying across the 
abdomen with its back toward either the front or back of the 



534 OBSTETRICS. 

mother. Often the physician, with her hands, can move the ex- 
tremities, which appear to the touch as small nodules and when 
found serve to show the position of the back. The fetus lies 
doubled up, the chin and arms upon the chest and the legs upon 
the abdomen. In the normal position the head is down, for it is 
the heaviest portion of a body floating in water, and the back is to 
the mother's left side. If this relation be still maintained when 
labor comes, the largest diameter of the child's head will cor- 
respond with the largest diameter of the mother's pelvis and thus 
facilitate an easy delivery. The next most frequent position is 
with the back to the right side of the mother's abdomen, the larg- 
est diameter of the head corresponding to a diameter of the pelvis, 
which is a little less than that in the former case and therefore 
causing a longer labor. Less frequently there are other positions 
of the Read, and, as they have to be changed into either the first 
or second position, they result in much delayed deliveries. 

Then, too, the breach or feet may come first, with the same 
relations of the back of the child to the sides of the mother. 
These are usually longer deliveries and more dangerous to the life 
of the child, for, as its head, the largest portion, comes last, it 
must be delivered quickly in spite of the lack of dilatation of the 
external outlet, for when the body comes in contact with the cooler 
external air the child begins to breathe and thus draws water into 
the lungs, just as a drowning person does, and in a few minutes 
is beyond recovery. The shoulders or side of the child sometimes 
presents first, but in such a case there is no possibility of delivery 
unless the fetus is very small and imperfect, and even then it is 
better if changed by manipulation into one of the other forms. 
A vaginal examination serves to confirm the external diagnosis 
of presentation and position, and often is the only way of reaching 
a positive conclusion. The diameters of the pelvis are determined 
by measurements with an instrument called a pelvimeter. 

Normal labor is the separation of the fetal and uterine mem- 
branes, accompanied by contractions of the uterine muscle and 
expulsion of the fetus at full term. These contractions are called 
pains because of the pain associated with them, due to the pres- 
sure on the uterine nerves during a contraction, to the stretching 
of the ligaments and the neck of the uterus, which is sometimes 
resistant, and to pressure upon neighboring organs. 

The susceptibility to pain varies in different individuals. The 



OBSTETRICS. 535 

very young mother and the woman who bears her first child late 
in life usually suffer most. A painless labor is very rare. I have 
attended just one — a Polish woman of twenty-five in her second 
delivery. The contractions were quite as forcible as in any nor- 
mal labor, but she persistently insisted that she felt no pain. 

At first the pain is in the back and sacrum, later in the abdo- 
men or down the thighs. The most severe pain is when the head 
passes the external pelvic outlet. Signs of beginning labor usu- 
ally occur about two weeks before delivery. There is a sinking 
of the fetus into the pelvis, thus allowing more breathing space, 
and the patient feels and eats better. This may be followed by 
irritability of the bladder and pressure upon the pelvic organs, 
and there may be intermittent pains. Other signs are a show of 
mucus streaked with blood, not constant, and increased vaginal 
secretions, but the most positive sign is regularly recurring pains, 
increasing in force with lessening intervals between. This is the 
period of dilatation of the mouth of the uterus and adjustment of 
the head of the child to the pelvic canal of the mother. The length 
of this time varies with the size of the mother's pelvis, the size of 
the child's head, the flexibility of the mother's joints and tissues, 
and the compressibility of the head or presenting part of the child. 
It is usually shorter when the head comes first. 

The pains at the beginning are half an hour apart and give 
but little discomfort, but they gradually come nearer and nearer 
together until there are but short intermissions. The average 
duration of the first stage in first labors is fifteen hours, and in 
other labors eight hours, but in the first labors of women about 
forty years of age it is over thirty hours, and it has been known 
to last several days. The second or expulsive stage lasts from ten 
minutes to six hours, its average in first labors being two hours, 
and in others one hour. The pains are now bearing down, tear- 
ing and hard, the result of nature's effort to drive down the fetus 
regardless of injury to tissues. This is the time of the greatest 
suffering, but it is usually better borne than the longer, nagging 
pains of the first stage. 

The third is the placental stage, that in which the membranes 
and placenta become separated from the uterus and expelled, and 
the uterus contracts. There is loss of blood, but usually it is not 
excessive. This stage generally lasts from twenty to thirty min- 
utes, but may continue two hours, or longer, if the placenta or 



536 - OBSTETRICS. 

membranes adhere to the uterus, in which case they must be re- 
moved by the physician. This is usually done within half an 
hour. 

ANTISEPTIC PRECAUTIONS. 

During the last twenty-five years the discovery and use of 
antiseptics and the knowledge of asepsis has revolutionized the 
art of surgery and obstetrics, so that the danger of child-bed fevers, 
where proper and intelligent care has been taken, is now prac- 
tically nothing. 

PREPARATION OF THE ROOM. 

The room in which the patient is to be confined should be 
well ventilated and sunny, and should contain only the furniture 
actually needed for comfort, as a bed, 'table, one or two chairs, a 
small bed for the baby, some provision for heating, plain, clean 
walls, clean, bare floor, with one or two rugs, and plain window 
shades, to moderate the light. All food and articles required for a 
change should, if possible, be kept in an adjoining room and be 
brought in as needed. As a means of heating, a stove in the room 
answers every purpose, aiding, too, in securing a gpod circulation 
of air, and convenient for disposing of soiled dressings which, if not 
burned, may be allowed to accumulate and become a breeding 
place for germs. The air should be as pure as possible and pre- 
vented, by the evaporation of water, from becoming too dry. The 
water closet must never communicate directly with the lying-in 
room; must always be ventilated from the outside, and its door 
should close automatically. 

PREPARATION OF THE BED. 

The bed should be made up with an absolutely clean mattress, 
fresh blankets and sheets, and padding that has been prepared 
by boiling, or subjection in an oven for an hour to a heat of 300 
degrees ; over the bed is the rubber or oilcloth that has been care- 
fully cleaned by sponging with a solution of bichloride of mercury, 
one part of the bichloride to one thousand parts of water, and over 
this a second clean sheet and padding prepared like the first. 

PREPARATION OF THE PATIENT. 

As soon as labor is certainly in progress the patient should be 
given a full bath in warm water, be scrubbed thoroughly with 



OBSTETRICS. 537 

soap, have the bowels moved by an enema, the external genitals, 
anus and neighboring parts washed with an antiseptic, be given 
an antiseptic vaginal injection and dressed in clean clothes. For 
the vaginal injection a solution of corrosive sublimate (bichloride 
of mercury), one part of the sublimate to five thousand parts of 
water (three grains to the quart) is effective, but as it is very 
poisonous care must be taken not to leave any of the solution 
where someone might drink it, and it must not be put into the 
rectum, neither must the tablets, often used for making this solu- 
tion, be left where children may handle or eat them. 

OTHER SAFETY MEASURES. 

All instruments to be used should be boiled for thirty min- 
utes before using and be touched only by hands that have been 
thoroughly disinfected. If a catheter is used it may, after the dis- 
infection, be oiled with sterilized vaseline and should be intro- 
duced by sight. No irritating antiseptic must be allowed to re- 
main upon the instrument lest it cause inflammation. All water 
used about the patient or upon the hands of the attendants must 
have been recently and thoroughly boiled, and all towels, pads, 
absorbents, bandages, articles of clothing and other things used 
at this time, and during the lying-in, must be carefully disin- 
fected. 

The hands of the patient, nurse and physician should also 
be disinfected. To do this, first scrape and clean the nails while 
dry, then scrub the hands and forearms for not less than ten 
minutes in strong soap and water as hot as can be borne, after 
which soak them three minutes in an antiseptic solution. That 
formed of one part of corrosive sublimate to one thousand parts 
of water is good. 

The nurse should have in readiness a table with basins of the 
antiseptic solution, plenty of clean towels, sterilized vaseline, good 
soap, absorbent cotton, a saturated solution of boric acid crystals 
for the eyes and powdered boric acid for the cord, one or two 
pieces of unbleached muslin a half yard wide by one and a fourth 
long for abdominal bandages, a fountain syringe, safety pins, an 
extra rubber sheet, a blanket for the child, and the child's cloth- 
ing, and see that there is plenty of previously boiled, and hot water 
obtainable at all times. 



538 OBSTETRICS. 

THE CARE OF THE CHILD. 

Immediately after birth clear the child's air passages of mucus, 
using the finger if necessary, and sever the navel cord when it 
stops pulsating; or before if any complication arises. Tie the cord 
twice, with narrow tape, about one inch and a half and two inches 
and a half from the body, and cut midway between these ligatures. 
The newborn must be protected against sudden chilling. A change 
of 30 degrees is usually fraught with danger. Wrap the child in a 
warm woolen blanket and immediately wash its eyes in warm wa- 
ter, containing all the boric acid crystals that it will dissolve, tak- 
ing great care to get out all the maternal secretions, then cover it, 
head and all, in the blanket and lay it in a warm place until the 
mother can receive attention. As soon as she has been cared 
for, the nurse should cleanse the baby by anointing it with sweet 
oil, vaseline or even fresh lard; then, if it be strong and healthy, 
by sponging it with warm water and a little non-irritating fluid 
soap ; but if the child is weak and feeble it should be cleansed with 
the oil or vaseline only, and kept a few days in warm flannels or 
cotton. The room must be well ventilated and of a warm and uni- 
form temperature, and a bath of water or oil given daily. Oil 
should always be used as a preliminary just before the first water 
bath. 

After the first bath, the best time for bathing is in the morn- 
ing midway between the feedings. After the stump falls off, 
daily sponging may be superseded by daily immersions in warm 
water. If any powder is needed for irritation between the folds 
of the skin, equal parts of lycopodium and oxide of zinc form a 
good one. 

There is no occasion for worry if the child does not pass urine 
for several hours, for it will not secrete much until it begins to 
nurse. In six or eight hours, when the mother has become well 
rested, it should be put to the breast, not only for nourishment 
and training to good habits, but for the tonic effect upon the 
uterus of the mother. The nipples are to be washed, both before 
and after nursing. Well-fed babies usually eat, sleep, grow and 
give little trouble, and rarely take contagious or infectious dis- 
eases; but the poorly nourished are nervous and irritable, fit sub- 
jects for all the prevalent ills. 



OBSTETRICS. 539 

THE CARE OF THE MOTHER. 

After the expulsion of the placenta the patient should be 
washed again and the vulva thoroughly cleansed. The use of a 
vaginal injection at this time depends upon the termination of the 
case and whether or not there is a necessity for it. If used the 
syringe nozzle must first have been boiled, or disinfected by soak- 
ing in the corrosive sublimate solution, then rinsed well in boiled 
water. The dressing consists of an occlusion bandage fastened 
tightly to the abdominal bandage. 

For the first few hours after labor the best position is upon 
the back, for if turned upon the side the heavy uterus falls for- 
ward and may draw air into the passages, exposing the patient to 
the risks of embolism. After the uterus has become firmly con- 
tracted there is no more danger in this direction and the patient 
may occupy any position she pleases while lying down. A sound 
sleep for several hours following labor is very favorable, and an 
important element in the restoration of the patient, hence an op- 
portunity for rest and sleep should be given as soon as mother 
and child have received proper attention. Have the room quiet 
and the light subdued. The child should not be allowed to dis- 
turb the mother's rest, hence must not be placed in the same bed 
and, if it cries, should be taken to another room. If after pains 
keep her awake a sedative is given according to the direction of 
the physician. 

Great care should be taken to keep clean the external genitals 
of the patient, her own linen and the bed clothing. The vulvar 
dressing should be changed every three or four hours for the 
first four or five days, and as often thereafter as soiled. When- 
ever it is changed the external genitals should be thoroughly 
cleansed with soap and water, followed by some antiseptic solu- 
tion. This is best applied with the fountain syringe, the water 
being caught in the bed-pan. The patient ought to be sponged 
frequently with tepid water, or alcohol and water, because of the 
great activity of the skin ; and a warm glow should be produced by 
friction with a towel. The draw sheet, a common sheet folded 
to four thicknesses and placed beneath the hips, can be easily 
removed whenever soiled. 

The air must be very pure, and fresh air should be admitted 
constantly from the outside through open windows, care being 
used to avoid draughts. The room must not be too dark, but the 



540 OBSTETRICS. 

infant's eyes must be protected from strong light until two or 
three weeks old. 

Urine should be passed in from six to eight hours after labor, 
and if all other means fail, the catheter must be used, the utmost 
care being taken to preserve absolute asepsis. Boiling in water 
for thirty minutes makes the catheter safe. The parts are to be 
washed in soap and sterilized water, and bathed with an antiseptic 
solution, then the catheter, oiled with vaseline sterilized by heat, 
should be passed by sight. 

The bowels ought to be moved in about thirty-six hours by 
some mild laxative, as a Seidlitz powder, or by a rectal injection 
of soap and water, a small injection of sweet oil, or a half pint of 
glycerin solution of one-fourth strength. 

DIET. 

The diet of the mother should be restricted for the first twen- 
ty-four hours to liquids. Food will not be tolerated after anesthe- 
tics until their effects have worn off. On the second day soft 
boiled eggs and semi-solid food may be taken, and thereafter a 
moderately full diet is permitted. The patient needs as liberal diet 
as she can digest, both for her own nutrition and that of her 
child, for she should nurse her babe not only for its welfare, but 
for her own good, unless some complication arises that makes it 
undesirable. 

NURSING. 

The child is put to the breast after six or eight hours, and 
not oftener than once in four hours thereafter, until the secretion 
of milk is well established, after which the baby should be nursed 
once in two hours by day and every three or four hours by night 
for the first five months. If the intervals are too long, the milk 
becomes too thin ; if too short, it becomes too rich ; and if of irreg- 
ular length the child's stomach is upset. 

If the breasts become overdistended they can be relieved by 
massage, by saline cathartics, by drinking less, or by wearing a 
compression bandage (a straight piece of cloth, cut out under 
the arms and for the neck, and pinned tightly around the body 
across the breasts), with circular openings for the nipples. 

If the nipples are small much trouble will be saved by putting 
the infant to the breasts before they become engorged. A little 
patience and perseverance will usually succeed, even if it does 



OBSTETRICS. 541 

not take hold well at first. As the child usually falls asleep after 
nursing, it is well to establish a regularity of feeding by waking it 
at the proper time. Regurgitation generally means an overfilled 
stomach. For the first two or three days a baby gets but little 
nourishment from nursing and needs but little. 

If it seems hungry it may be pacified by a teaspoonful of warm 
water, or cows' milk, one volume of milk to two of water. Give 
up to one ounce at a feeding. From ten to twenty minutes is 
enough for each nursing, and it is better to apply the child to both 
breasts each time, unless some complication intervenes. It is 
well to weigh the child once a week, for an increase in weight is 
a proof of good health. If it does not continuously gain, at least 
five ounces a week for the first five months, the reason must be 
sought in the surroundings, or lack of nourishment or warmth. 
If, as often happens in weak women, the milk is deficient, the in- 
fant's lack of nourishment is soon evident, and something must 
be done to improve the quality and quantity of the breast milk, or 
artificial food be drawn upon to supply the deficiency. 

ARTIFICIAL FEEDING. 

When the baby must be artificially fed, cows' milk is best, 
modified to approximate human milk, then further modified by 
experiment to suit the individual child. Mixed milk from a herd 
is more likely to be uniform in quality than the milk of one cow, 
and less likely to spread disease. The following Meigs-Rotch 
mixture is one of the best : 

Cows' milk, mixed herd two ounces 

Cream three ounces 

Water, boiled ten ounces 

Sugar of milk three-fourths of an ounce 

Lime water one ounce 

Whenever indicated by the condition of the child these pro- 
portions should be changed to meet the emergency. The capac- 
ity of a child's stomach is about one ounce at birth and increases 
at the average rate of one and a half drams a week for the first six 
months. This, of course, is only a general average. 

The milk should be given at a temperature of ioo degrees. 
Milk may be completely sterilized by long boiling, but this destroys 
some of its chemical constituents and makes it indigestible. A 
partial sterilization at 167 degrees has been found to render milk 



542 - OBSTETRICS. 

practically sterile for twenty-four hours, without impairing its 
qualities. If a wet nurse is to be obtained the selection depends 
upon her health and age, and the age of her own child, which 
should be near that of the foster child. She must be free from 
syphilis, tuberculosis and all other contagious and infectious dis- 
eases. In the majority of cases good cows' milk properly modified 
is preferable to the wet nurse. 

Since cows" milk, modified according to the needs of each 
case, furnishes the most perfect food for infants deprived of the 
mother's milk, the artificial foods with which the markets are 
flooded should be avoided, except in some cases of intestinal trou- 
bles, when a substitution for a week or two affords a change of 
diet and sufficient nourishment. A child will often grow fat while 
taking them as permanent food, but, as they contain a greater pro- 
portion of sugar and starch than of albumen, they promote the 
formation of fat cells rather than the growth of muscular and or- 
ganic tissues, thus entailing a diminished power of resistance to 
disease, with all its disastrous results. 

Condensed milk, when diluted to give a proper proportion 
of albumen, is deficient in fats, and, in the unsweetened brands, in 
sugar also. If the sweetened brands contain cane sugar they pro- 
mote acid fermentation. Cane sugar is not an ingredient of milk 
and should never be used as a substitute for milk sugar. A con- 
densed milk, whose proportions are known, can be used as a base 
upon which to construct a suitable food by the addition of the nec- 
essary ingredients. 

THE CHILD'S CLOTHING. 

It should be loose and easily changed. The belly band, used 
to retain the navel dressings, is removed as soon as the cord is 
healed, and, while worn, must not be tight lest it favor navel pro- 
trusion. The customary triangular diaper of muslin or linen, fast- 
ened by a safety pin, is all that is needed for convenience. Rub- 
ber napkin covers are unsanitary and should not be used. The 
undershirt should be of knit wool, or made of softest flannel and 
open in front. The next garment is a flannel dress, with high 
neck and long sleeves, twenty-five inches in length and cut in 
princess style ; the outer dress of muslin is made in the same way. 
The feet and legs must be protected by woolen stockings reaching 
to the knees. The underskirt and dresses may be fastened with 



OBSTETRICS. h±6 

tapes. In warm weather the sleeves of the flannel dress may be 
removed. Some choose to lit a cotton waist, cut in princess 
style, to the top of the flannel skirt. The outer dress may be made 
with a yoke if preferred, and as tastefully decorated as one may 
please, provided stiff ruffles and starched garments are not put 
upon the baby. All the clothing must be changed daily. 



CHAPTER IV. 

CONVALESCENCE. 

The period of convalescence from childbirth is about six 
weeks. It begins at the end of the third stage of labor and is the 
time occupied by the uterus and its appendages in returning to a 
fairly normal condition. In exceptional cases it may last ten or 
twelve weeks, or even longer. While labor is a physiological 
process, the excessive waste and repair which belong to this 
period, united w 7 ith peculiar nervous irritability, make the patient 
very susceptible to outside influences and contagious and infec- 
tious diseases, and require the most perfect neatness in a surgical 
sense. 

Often, after labor, there is a feeling of chilliness, or even a 
rigor, which does not last over ten minutes and is not accompanied 
by a rise of temperature. For this a warm drink, warm coverings 
and hot water bottles should be provided. 

Uterine contractions continue a few days after the expulsion 
of the afterbirth. They expel blood clots from the uterine cavity, 
aid in the return of the uterus to its normal size and prevent ex- 
cessive bleeding, and as they are stronger when the child nurses, 
the mother recovers more quickly and completely from the effects 
of pregnancy and labor when she can nurse her child. The nervous 
pains, which are often a complication at this time, are of no value 
in recovery and ought to be relieved by medicinal remedies. The 
discharge from the uterus is called lochia and for the first three 
or four days consists of blood with clots and shreds of the decidual 
membrane of the uterus, after which it is lighter in color and con- 
sists mainly of blood serum, later still becoming a grayish yellow 
of creamy consistency. Gradually diminishing it ceases entirely 
in from two to six weeks. 

The breasts become enlarged during pregnancy, through the 
growth of lobules and increase of fat and connective tissue. Their 
secretion the first few days after labor is like that in the latter days 
of pregnancy and is called colostrum. It is more laxative than 
milk. In women who have borne children the milk secretion be- 

544 



OBSTETRICS. 545 

gins the second day, but with the first child it does not usually be- 
gin until the third day. There is more or less nervous disturbance 
at this time, with a little rise in temperature accompanied by thirst 
and loss of appetite. The swollen, overdistended breasts may be 
painful from pressure and must be relieved by nursing, or by arti- 
ficial draining with a breast pump, and by massage. 

The length of time that a lying-in patient should be kept at 
rest depends upon the rapidity of the uterine involution (contrac- 
tion to natural size). After the first nine days she may be allowed 
to get up, but should keep the recumbent position most of the 
time. During the third week she may rest in the chair the greater 
part of the day, but should keep her room until the end of the 
fourth week, and during the next two weeks only the very lightest 
duties are permissible. Of course, there are exceptions to all 
rules, but this is the course to be pursued by the average woman, 
and even the strongest can ill afford the hazard of imprudence and 
overexertion at this time. 

EFFECTS OF CHILDBIRTH. 

The great dilatation which takes place during the expulsion of 
the fetus tends to rend the adjacent tissues. During first labors 
very few escape without rents in the mouth of the uterus, the vagi- 
nal membrane and perineum. The more expulsive the pains and 
rapid the labor the greater the danger in this respect. There is a 
vast difference in the elasticity of tissues, so that some women 
with small external genitals may bear children without any wounds, 
while others, who are large and would seem likely to escape, suffer 
great laceration. When the first labor occurs as late in life as the 
thirty-fifth year there is the greatest danger of this complication, 
but by recognizing the coming peril it is often possible, by proper 
manipulation, to avoid it. In nine cases out of ten this can be 
done in all labors after the first, and the severity even of first labors 
can be greatly mitigated by proper care. Superficial tears will heal 
with only antiseptic treatment. All others, especially when 
there is hemorrhage, should be closed with stitches. Union by 
first intention usually takes place. If there is much swelling about 
the urethra it may be necessary to use the catheter for a few days. 
The patient may be sufficiently relieved by hot water in a bed-pan 
so placed that the steam will come in contact with the swollen 
parts. 

35 



546 OBSTETRICS. 

Lacerations of the perineum are the most common and they 
differ much in extent. Chloroform inhalations and moist applica- 
tions during labor will often soften this part. The after treatment 
consists in irrigating the wound with antiseptic washes, keeping 
the parts covered with the proper dressings and being careful that 
the nozzle of the syringe is made perfectly clean by being boiled 
thoroughly before each using, and that it does not separate the 
edges of the wound upon its introduction. With this kind of treat- 
ment a large majority of the cases will heal by first intention and 
the others, with some loss of tissue, by granulation. When there 
has been great pressure and contusion of the tissues it is sometimes 
impossible to save them all, and the antiseptic irrigation must be 
kept up freely to prevent blood poisoning. 

PUERPERAL INFECTION. CHILD-BED FEVER. 

One of the great dangers of childbirth which has been very 
materially lessened in the last few years, by the knowledge and care 
of the physician, is puerperal infection, which in certain places at 
different times has been so epidemic as to appall not only the preg- 
nant woman, but the care-takers as well. The changes which oc- 
cur in the tissues coincident with the growth of the fetus render 
the pregnant very susceptible to danger from without, and, later, 
in connection with the swollen and lacerated birth-canal, furnish 
a condition most favorable for the invasion of poisonous germs. 
The most common germs of puerperal infection are few in num- 
ber and are detected by a bacteriological examinaton of the vaginal 
discharges and debris from the mucous membranes of the uterus. 
This infection may be general or only local. The iatter is confined 
to the vagina and uterus, and is much less serious than the former, 
which affects the whole system, and may prove so destructive as 
to render recoverv impossible. 

The treatment lies mainly in prevention. The source of the 
disease being known, it is possible to avoid the cause. This lies 
in a careful selection of the proper surroundings and painstaking 
care to secure surgical cleanliness. The most frequent cause of 
septic infection is the neglect of proper care of the hands, dress- 
ings, instruments, and room, and contaminations from foul air as 
from water closets or defective drainage. In hospitals there is 
danger from suppurating wounds. 

As already stated, the mattress and all other parts of the bed, 



OBSTETRICS. 547 

occupied during confinement and the lying-in, should be abso- 
lutely clean ; and we repeat that the pads and sheetings should be 
thoroughly boiled and dried, the dressings made antiseptic by 
boiline or dry heat, all utensils used cleansed bv boiling, and all 
water for cleaning or other purposes boiled for thirty minutes, 
then cooled to the proper temperature. Before dressing the pa- 
tient or removing any bandages, the nurse should always cleanse 
her hands with soap and hot water, paying particular attention to 
the nails, and the perfect cleanliness of her clothing must be main- 
tained. 

All dressings should be burned on removal, or cleansed and 
boiled for an hour before being used again, either by the patient or 
anyone else, and let it be remembered that while infection usually 
takes place at the time of delivery it may occur either before or 
after. 

Confinement either in the country or city is open to more 
dangers from infection than it is in a hospital, because antiseptic 
precautions are less strict in private homes, their drainage is more 
liable to be imperfect and refuse is not always promptly and en- 
tirely removed. 

SUBINVOLUTION. 

Under the most favorable conditions the uterus does not re- 
turn to its normal size until from six to ten weeks after labor. 
An arrest of this process of retraction of the uterus or its ligaments 
is known as subinvolution and gives rise later to much of the dis- 
comfort which falls to the lot of woman when the pelvic organs are 
the seat of disease. The changes in the uterus and its appendages, 
brought about after labor, are due to a lack of blood, the supply of 
which is lessened by the contraction of the uterine muscular libers. 
Failure of proper reduction is also due to some interference with 
the blood supply. The most common causes are changes in the 
mucous membrane of the uterus from disease, an oversupply of 
blood during the last months of pregnancy, inflammation coming 
on after labor, displacement and polypoid growths. Later the 
cause may be chronic constipation, assuming too soon the erect 
position, too much exercise or hard work, and resuming sexual in- 
tercourse too soon after labor. Any of these things may not only 
retard, but arrest the changes so necessary to a healthy condition. 
A failure to nurse the child may predispose to subinvolution, and 



548 OBSTETRICS. 

immediately after labor large blood clots, a distended bladder, or 
displacement of the uterus itself may do the same. It may occur 
in women who lack muscular tone, or are predisposed to various 
diseases, but this is exceptional. Usually there is a local cause. 
Subinvolution is often the cause of ill-health from pelvic disor- 
ders. The physician should be given an opportunity to correct 
all such disorders as soon after labor as permissible, since later 
they are not nearly as amenable to treatment. 

During the lying-in, abdominal palpation will show the prog- 
ress that the uterus is making in return to a normal size. A fair es- 
timation of its progress may be obtained by a daily examination 
of the abdomen with the hand. In a general way it may be said 
that the day after delivery the body of the uterus is a finger above 
the navel, on the third and fourth days slightly below, on the fifth 
and sixth days two fingers below, on the seventh, eighth and ninth 
days three or four fingers above the pubis, on the tenth, eleventh 
and twelfth days slightly above, on a level or a little below the 
pubis. This decrease continues until the tenth or twelfth week, 
when the size of the uterus will be found to be less than normal, 
after this, engorgements usually give a slight permanent enlarge- 
ment. 

When the involution fails to properly take place there will 
be an increase and prolongation of the bloody discharge, a coated 
tongue and constipation. If involution be permanently arrested 
there will be connective tissue development in the uterine walls 
and changes of the mucous membrane, and chronic inflammation 
will be established in the linings of the cervix and uterus. 

The treatment consists of the removal of all causes which 
may prevent the return of the uterus to its normai condition. If 
not noticed until several weeks after labor there will be frequent 
bleedings, leucorrheal discharges, dragging sensations, a feeling 
of weight and distress in the back and loins, and finally the diges- 
tive, circulatory and reflex nervous symptoms of subacute and 
chronic inflammation will appear. 

INCONTINENCE OF URINE. 

After labor there may be inability either to retain the urine, or 
to urinate at all. Either condition is annoying and may give rise 
to serious consequences. The loss of power to empty the bladder 
may be due to the position — lying on the back — or to injury to the 



OBSTETRICS. 549 

urethra or to the front vaginal wall, and resultant swelling. The 
bladder must then be emptied by a catheter because of the danger 
of inflammation, or even of infection, if the bladder, from too great 
distention, loses its normal tone. 

A constant dribbling of urine often means an overflow from 
a distended bladder, and partial paralysis of the sphincter of the 
urethra caused by injury during labor. The trouble often disap- 
pears spontaneously, but may linger for some time. Recovery 
can be hastened by tonics and electricity. 

NERVOUS COMPLICATIONS. 

The nervous system also suffers from the additional burden of 
pregnancy and the shock of labor. Apoplexy at this stage is more 
frequent in those who are pregnant, or have just been through de- 
livery. Paralysis following labor is due to injury from pressure by 
the head or instruments, and, again, from failure to use forceps at 
the proper time, thus allowing the pelvic nerves to be injured by 
continued pressure. Septic neuritis gives rise to the same symp- 
toms as are seen in ordinary neuritis. 

SORE NIPPLES. 

Sore nipples are very frequent in first pregnancies and are 
often due to imperfect development. Small nipples can easily be 
increased in size by manipulation during the last months of preg- 
nancy and much discomfort and danger thus be averted. Hiibner 
states that fifty-one per cent of nursing mothers have sore nipples 
between the third and fifth days. The nipples should be protected 
from pressure from corsets and tight clothing during pregnancy, 
and, during the last months, washed twice daily with bland soap 
and water, then anointed with cocoa butter or sweet oil, and, once 
each day, treated with a saturated solution of alum or a 25 per 
cent solution of glycerole of tannin. If the latter be used the un- 
derclothing must not come in contact with it, because of its perma- 
nent stain. 

From the first nursing, close attention must be given to clean- 
liness of the child's mouth. It should be washed out once a day or 
oftener with a saturated solution of boric acid, and after each nurs- 
ing the nipples should be washed with the same solution and dried. 
If at all inflamed they must be covered with a protective ointment 
as follows : 



550 - OBSTETRICS. 

Boric acid fifteen grains 

Castor oil . . two drams 

Subnitrate of bismuth two drams 

This may be alternated with extract of witch hazel, diluted 
with three or four times its volume of water. When there are raw 
places or cracks on the surface of the nipples use a mixture made of 
twenty grains of boric acid and one ounce of oxide of zinc oint- 
ment ; also paint them with the compound tincture of benzoin. A 
breast-binder and a nipple-shield, made of a glass bulb and a soft 
rubber nipple, should be used to save the mother as much pain 
as possible. The nipple is cleansed thoroughly after nursing and 
kept in a boric acid solution, and the glass bulb washed occa- 
sionally in a five-per-cent solution of carbolic acid, or boiled for 
thirty minutes. If the shield aggravates the trouble by pres- 
sure upon a fissure, nursing may have to be given up for a day or 
two, and artificial feeding resorted to, until healing takes place. 
Only the most serious circumstances and fear of certain abscess 
should lead to drying up the milk for relief, unless there is no 
prospect of the nipples performing their duty because of deformity, 
or of easy erosion upon any manipulation. 

Abscess of the nipple should receive the proper surgical treat- 
ment, and eczema, herpes zoster and syphilitic ulcers must have 
proper local and constitutional treatment. 

Engorgement of the breasts may be prevented by skillful mas- 
sage. If they become suddenly engorged by an oversecretion of 
milk or exposure to cold, they must be relieved by nursing the 
child more frequently, by massage or by the breast pump. In addi- 
tion to this a free movement of the bowels by a cablespoonful of 
Epsom salts in a half glass of warm water before breakfast, and 
compression of the breasts by a bandage will prevent further 
trouble. 

ABSCESS OF THE BREAST. 

Abscesses of the breast are of three kinds: i. Those in the 
glandular tissue itself, called the parenchymatous. 2. Those in the 
connective tissue just beneath the skin, called the subcutaneous. 
3. Those in the deep connective tissue beneath the gland called 
the post mammary. The latter form is rare. 

All the forms are of microbic origin — the germs entering 
through the erosions or fissures upon the nipples and, as a rule, 



OBSTETRICS. 551 

coming from the baby's mouth. A failure to properly empty the 
milk glands gives rise to a stoppage or stagnation which is a pre- 
disposing factor, in a mammary abscess.' There is one other source 
of infection, a rare one, and that is through the mother's blood sup- 
ply, excretions being thrown off by the mammary glands as well 
as by the other glands of the body. 

Preventive treatment consists, as we have already said, in 
care of the breasts during the- later months of pregnancy and in 
strict cleanliness in caring for the nipples. For the glandular 
form, when inflammation is threatening, massage and the breast 
pump should be employed. These measures would be harmful 
in a subcutaneous case. In that form an ice bag should be applied 
to the inflamed part and alternated with a lead water and laudanum 
compress, and the patient should also take free saline cathartics. 
Although these remedies constitute the best treatment they may 
be unable to arrest the abscess, and suppuration may follow. Mam- 
mary abscesses are rarely dangerous to life, but if neglected a 
large portion, or all of the gland may be rendered useless for fu- 
ture nursing. When, for any cause, it is necessary to stop the 
secretion of milk immediately after deliver}", it may be done by a 
compression bandage and saline cathartics, and, if the patient can 
stand it, by massage and the breast pump to prevent engorgement. 

QUALITY OF THE MILK. 

The quality of the milk may be a source of great trouble. The 
fats and albuminoids show the greatest changes, and this is often 
aggravated by the manner of putting the infant to the breast ; as 
too frequent, or too prolonged and irregular feedings, alter the 
milk and render it either difficult of digestion or of little nutritional 
value. When the baby is nursed oftener than once in two or 
three hours the milk becomes so concentrated that it is diffi- 
cult to digest, and makes the child feverish and thirsty, 
and when the interval between the feedings is prolonged beyond 
the usual time the milk becomes so reduced as to impair its nutri- 
tion. The diet of the mother is also a large factor in influencing 
the quality of the milk. 

Living largely upon vegetables will increase the proportion 
of sugar and diminish the fat and casein, while an excess of 
albuminous food will increase the fat and casein and diminish 
the suear. In each case the infant receives food ill-adapted to its 



&' 



552 OBSTETRICS. 

needs. The employment of alcohol and malt liquors increases the 
fat and casein. While it is sometimes necessary to add some 
preparation of malt to the mother's diet, the indiscriminate use of 
it can only be productive of harm. The diet of the nursing woman 
should not differ from the plain mixed diet to which she has been 
accustomed, with, however, a moderate excess of fluids. Of 
these, milk taken between meals is the best. Tea and coffee are 
better withheld, or taken dilute and in small quantities. Cocoa 
is sometimes useful. 

In some cases in spite of every variety of diet to secure a 
proper consistency of milk for the child, it fails in nutrition and an 
artificial diet must be substituted. Sudden fright, joy or great 
anxiety have a peculiar effect upon the quality of the milk, giving 
rise to indigestion in the infant. This should teach the mother to 
lead, as far as possible, a quiet, unemotional life during lactation. 
The quantity of milk varies from total absence of secretion to 
an excessive supply. Usually at the seventh day there are fourteen 
ounces in the twenty-four hours, at six weeks it reaches about two 
pints; at the seventh month three pints and after the eighth 
month it gradually decreases. 

A mother with tuberculosis should not nurse her child since 
it would reduce her strength and expose the child to infection ; 
neither should one having goiter, or a predisposition to it, for 
nursing aggravates this disease ; and if anemia exists to any great 
extent the welfare of both mother and child demands artificial 
feeding. The advisability of discontinuing nursing when the 
menses appear depends entirely upon its effect upon the child and 
mother. Various drugs taken by the mother appear in the milk 
and may produce an injurious effect upon the child. 

WEANING THE CHILD. 

Weaning the child aiso depends upon the quantity and quality 
of the milk and the effect of nursing upon the mother's health. At 
nine months the baby can usually be fed without trouble. At 
twelve months there are so great changes in the milk that weaning 
is desirable, unless it is in midsummer, or the child is recovering 
from severe illness. Most serious derangements of the system may 
follow prolonged nursing, particularly of the mother, who can 
hardly escape feeling the strain of the unusual drain. 



OBSTETRICS. 553 

WEIGHT. 

The average new-born child at first weighs seven pounds, a 
boy being about a half pound heavier than a girl. A child may 
weigh much less, yet be perfectly formed, while a few weigh ten 
or twelve pounds. The weight is affected by the length of the 
pregnancy, the nourishment of the fetus, the size of the mother, 
her age (young mothers have small children), and the number of 
previous pregnancies — the weight increasing up to the fourth or 
fifth child. There is usually a loss of weight for two or three days 
after birth, but when the milk comes the infant begins to grow 
and at the end of the first week is about as heavy as at birth. An 
average child will gain from one-half to three-fourths of an ounce 
daily for the first year. There may be periods when there is no 
gain, followed by periods of increased gain. The average child 
at three months weighs ten pounds, at six months from thirteen 
to fourteen pounds; at nine months from sixteen to seventeen, 
and at one year from nineteen to twenty pounds. Its length at 
first is from nineteen to twenty inches and it gains from six to ten 
inches the first year. 

The respirations of the new-born are irregular and rapid, 
about forty per minute. The air cells do not expand until the sec- 
ond day. There is in its respiration elevation of the ribs, a large 
part of the work being done by the diaphragm. When the navel 
cord is tied the entire circulation changes, the lungs now receiving 
the blood for aeration as well as for nourishment of their own 
tissues. The vessels that connected the mother's circulation 
through the placenta are immediately blocked with clots and ulti- 
mately become fibrous cords. For the first lew months the pulse 
is feeble and rapid, easily disturbed and quickened. During sleep 
it is about 120 beats per minute, 130 while awake, and 140 or 150 

if excited. 

DIGESTION. 

Saliva is secreted at birth, but in very small quantities. Its 
diastatic power is weak at first, but gradually increases during the 
year and at the end of that time is nearly equal to chat of the adult. 
The stomach is small, more cylindrical, more vertically situated 
than later in life, and of less muscular power. Food in the stomach 
diminishes rapidly the first hour and disappears entirely in two or 
two and a half hours. Water assists in the digestion of casein. 

The liver is so large at birth as to occupy a very large 



554 OBSTETRICS. 

part of the entire abdominal cavity. Bile is secreted early and 
gives to the feces their light brown color. In the new-born they 
consist for the first few days of meconium, a dark, thick, blackish 
substance, which, about the fourth day, is mixed with digested 
milk, so that after this time the feces consist of the residuum of 
digested milk. They are passed from two to four times daily. 

The kidneys are fully developed and functionally active at 
birth, the secretion of urine taking place before birth. The skin 
at delivery, because of an interference with the circulation, is of 
a livid hue, which changes, on the establishment of respiration, to 
a deep red; later it becomes yellowish and finally in about three 
weeks assumes the rosy tint common to infancy. 

The development of the nervous system depends largely upon 
heredity, environment and the health of the child. Not until after 
the first month does the gray matter appear in the brain. The 
medulla and cord centers are much better developed at birth than 
the cerebrum. The special senses respond, to stimuli at this time, 
but in a limited degree. Taste and smell can be roused by strong 
stimulation immediately after birth, but the hearing is imperfect, 
the sight is but feebly developed for the first two to six weeks, and 
the sense of feeling or touch is very feeble at first. 

Most children walk when a year old, some earlier and others 
later. Speech is gradually developed, there being no distinct 
words until the end of the first year, and often not until much later. 

PATHOLOGY. 

Such of the conditions and diseases as are treated elsewhere 
in this work we mention here only to call attention to their liability 
to appear in infancy, and to suggest precautions. 

Bruises. — There are often bruises upon the presenting part 
of the child, usually upon the head. They come in long con- 
tinued labors from pressure in the adaptation of the head to the 
pelvic canal of the mother! There is localized swelling of the 
scalp and connective tissue and some accumulation of blood, 
like the black and blue spot of an ordinary bruise. The affection 
is present at birth, if at all, and usually disappears without treat- 
ment. 

Cephalhematoma may be single or double, and does not ap- 
pear until two to four days after birth. It is also caused by pressure 
and is always confined to the surface of one of the cranial bones, 



OBSTETRICS. 555 

never crossing a suture or fontanelle. It is possibly clue to a weak- 
ness of blood vessels, which allow a hemorrhage upon pressure. 
There is no discoloration of the scalp and the tumor is not pain- 
ful. It disappears in from four to ten weeks. 

Discolorations. — During early life there is an exfoliation aris- 
ing from irritation of the very delicate skin and mucous mem- 
branes. Thus eczemas and eruptions are easily developed. The 
icterus neonatorum, which occurs in about eighty per cent of the 
new-born, is not a disease, but simply a discoloration of the skin 
which takes place during the first two weeks of the child's life 
and disappears when the body has adjusted itself to its new sur- 
roundings. 

Mastitis, accompanied by secretions in the breasts of both 
male and female children, occurs quite frequently during the 
first two weeks after birth. There is swelling, redness and pain 
which will subside in about two weeks without any treatment, ex- 
cept to cover the breasts with vaseline and borated cotton, or, in 
case of much swelling and redness of the skin, to use an antiseptic 
wet dressing. 

The Navel Cord dries up and drops off usually about the 
fourth to sixth day, and the scar will then be clean, but will re- 
main soft until the twelfth day. In some cases the stump does 
not drop off until the fifteenth day or later. The navel wound is 
the most common spot of septic infection in the new-born, and 
should be dressed antiseptically under the physician's care. 

If the ligature is not properly tied there may be a hemorrhage 
before the separation of the cord ; again there may be no hemor- 
rhage even if the cord is not tied. But with asphyxia of the first 
degree, and a strong heart beat, there would be hemorrhage 
from the cord if not properly secured. 

The pulsation first stops in that part of the cord next to the 
placenta, then gradually lessens along the whole line as the cir- 
culation of the infant adjusts itself. If the cord dries up as it 
should a few days after birth, it effectually prevents hemorrhage, 
but should it become gangrenous the arteries might expand and 
permit bleeding. To prevent hemorrhage the ligature should be 
tied about an inch and a half from the navel, care being used to 
make it firm and not to cut into the tissue. If the navel end is 
too short, or has been torn off, a compression bandage should be 
used, or the individual vessels be secured by stitches. When the 
cord is very soft and tender an elastic ligature may be used. 



556 - OBSTETRICS. 

When the bleeding from the navel wound exceeds a few drops 
it is usually constitutional and may be due to hereditary syphilis, 
septic poisoning, or acute fatty degeneration, but these causes 
are exceedingly rare. 

If the navel wound does not heal readily, because of friction 
or lack of cleanliness, ulceration may occur. This should be 
treated with an antiseptic solution, as a saturated solution of 
boric acid, followed by a dressing of one part of powdered salicylic 
acid to four parts of starch. The stump should thus be dressed 
three times daily. 

Should the wound heal slowly and pus form there may be a 
granular growth, which, until removed, will prevent further heal- 
ing. This condition is best treated by touching the growth with 
nitrate of silver, then applying a bandage wet in an antiseptic 
solution. If the growth be cut away hemorrhage is likely to 
follow. 

Navel cord rupture (hernia) is caused by a partial failure 
in the development of the abdominal walls in the first stages of 
fetal life. The treatment consists of applying antiseptic dressings 
to dry up the cord and, as soon as the stump becomes detached, 
reducing the hernia and holding the parts in place by adhesive 
bands ; or of the radical operation, which should be performed 
shortly after birth, by the surgeon. 

Septic Infectio7i may take place before birth, and show itself, 
three or more days after birth, in a number of forms which are 
hard to distinguish. When strict antiseptic precautions are not 
taken infection of the navel wound is likely to occur, which may 
be complicated by an inflammation of the neighboring arteries 
and veins, and possibly of the surrounding tissues. Gangrene 
may be caused by ulcers of the navel if the patient be neglected. 
The treatment of all infectious wounds consists in the use of anti- 
septic dressings and such internal remedies as will keep up the 
strength and general health. These remedies are often best sup- 
plied through the proper diet of the mother. Any injury to the 
skin may become an infected sore if not antiseptically dressed. 

Pemphigus, aside from syphilis, is rare. It consists of vesi- 
cles, varying in size from that of a pea to a hen's egg, and of 
round or oval shape, of which there may be many or only a few. 
It differs from syphilis in appearing upon the body only, not also 
upon the soles and palms. The vesicles look like blisters rilled 



OBSTETRICS. 557 

with serum. The disease is probably contagious, but is not easily 
transmitted to an adult. Its treatment consists in protecting the 
blisters from injury and, upon their breaking, dusting upon the 
raw surfaces a one to four mixture of salicylic acid and starch. 
Tetanus of the new-born is also a germ disease, the infection 
entering through the navel wound. It is extremely rare, except 
in most neglected cases, especially where moist filthy dressings 
are used for the stump, by uncivilized people. 

Gonorrheal infection from the mother is often transmitted to 
the genital tract of the female child and is the cause of leucorrheal 
discharge in early life. 

Syphilis is more often acquired than. is supposed. It may be 
contracted from a wet nurse, who may be uninfected herself, but 
is also nursing a child that is infected. Infants may contract this 
disease from other members of the family, or may give it to them. 
Infection most often takes place from sores around or within the 
mouth, and is especially likely to be transmitted by kissing. None 
but intimate friends known to be pure should be allowed to kiss 
the baby. On the other hand a child with a syphilitic affection 
is a constant source of danger to those with whom it comes in con- 
tact. The treatment is similar to that for an adult, and should be 
under the direction of a physician. 

Infantile Sore Eyes is a very serious disease, contracted usu- 
ally during birth, by infection getting into the eyes while passing 
through the vaginal canal, but it may also be taken from in- 
fected amniotic fluid before birth, from the water, utensils or cloths 
used in bathing, from the hands of attendants, and from instru- 
ments. It may also be indirectly passed in many ways from the 
eyes of one child to those of another. The first symptoms usu- 
ally occur from the third to the fifth day. There is redness of the 
lids and a thin secretion of pus, which later becomes very abun- 
dant and thick. Thirty per cent of all blindness is said to be due 
to this disease. As a preventive measure, in all cases of sus- 
pected gonorrhea, the vaginal canal must be made antiseptic by 
vaginal douches, before delivery. (For treatment see Diseases of 
the Eye and Ear.) 

La Grippe r in very young infants is hard to diagnose, unless 
other members of the family are thus afflicted, in which case it is 
probable that rise in temperature, accompanied by great depres- 



558 OBSTETRICS. 

sion, is due to this cause and treatment should be given along the 
same lines as those laid down for adults. 

Thrush is an infantile mouth disease due to a parasite and 
occurs in poorly nourished and artificially fed children. The treat- 
ment consists of removing the patches by a saturated solution of 
boric acid. The application should be made very gently to avoid 
unnecessary scaling of the mucous membrane. If the child nurses 
the nipples should be washed in the same solution after each 
nursing. When artificially fed the food should be made alkaline 
with lime water. Gonorrheal infection will produce a catarrhal 
affection of the mouth, which should be treated in the same way 
as thrush. 

Apthce is a more serious affection in which plainly discolored 
spots appear in the mouth and change into shallow ulcers. They 
are also probably due to germs and the treatment is essentially 
the same as for thrush, but must be more persistent and with 
stronger remedies. 

Nasal Catarrh in very young infants is usually due to syphilis, 
but may arise from infection received while passing through the 
birth canal. The treatment consists of clearing the nasal passages 
with a mild solution of boric acid crystals by means of a small 
syringe or medicine dropper. 

Colic is an early cause of discomfort to infants and is usually 
due to imperfect digestion, caused by improper food. The symp- 
toms are sudden attacks of pain, shown by refusal to nurse, draw- 
ing up the limbs and crying, and are quickly relieved upon the 
expulsion of gas. Dry heat applied to the abdomen, friction 
across the lower part of the abdomen, or a warm bath, will give 
great relief. A soft tube introduced into the rectum will allow the 
gas to escape, and an injection of water or oil will secure a good 
movement if the bowels are constipated. The food must be care- 
fully regulated. A drop of the essence of peppermint in a tea- 
spoonful of hot water, or a grain of pepsin, or half teaspoonful 
of the milk of asafetida is very effective for the relief of pain. 
Paregoric, opiates in any form, and soothing syrups of the vari- 
ous kinds, should never be used. 

The Diarrhea of the new-born is due to improper feeding or to 
exposure to rapid changes of temperature. If not corrected by 
the substitution of the proper food with from one-twentieth to 
one-tenth of a grain of calomel three or four times a day, give 



OBSTETRICS. 559 

three grains of subnitrate of bismuth and two to four drops of 
aromatic sulphuric acid to check the frequent movements of the 
bowels. 

Constipation is very common, even in the new-born. The in- 
testines in children are larger proportionately than in the adult, 
and their walls are thinner and weaker, because of the lack of de- 
velopment in the muscular coat. Excessive constipation in the 
mother, the small residuum from a milk diet, deficient intestinal 
secretion, excessive perspiration, rupture, and intestinal deformity, 
all are causes. The usual treatment is a change of diet, partially at 
least, if the child is artificially fed. The local effect of soap or 
glycerin suppositories, or an enema of water and glycerin, a half 
part solution, should also be obtained. Obstruction of the bowel 
demands surgical aid. 

Ruptures in children are usually remediable and curable by 
means of properly fitting trusses. 

Uric Acid in the urine may be corrected by small doses of 
sweet spirits of niter, and lime water in the milk. 

Phimosis or elongation of the prepuce with contraction may 
give rise to irritation, or even to convulsions. Treatment consists 
in cleanliness and a retraction every day, or, if this cannot be done, 
in a dilatation with forceps and a breaking up of the adhesions with 
a probe. Should there still be irritation or further trouble re- 
sulting from the elongation, circumcision should be performed. 

Premature Birth is the term applied to a child born between 
the time at which it is capable of living and full term, whether 
the birth be natural or produced. Its possibilities of living will 
depend upon the supply of proper warmth and nourishment with- 
out too great exhaustion. Other things being equal, the nearer 
it has approached to full term the better its chances for living. A 
healthy child born prematurely when the time of full term has 
arrived has equal chances with one born through natural labor at 
full term. 

An incubator best provides the uniformity of temperature 
required for a premature child. There must be as little disturb- 
ance as possible for feeding and bathing. If covered with cotton 
wool it need not be dressed at all. It should be bathed only in 
sweet oil, to secure cleanliness, and its napkins removed only when 
necessity requires. It should not be removed from the incubator 
to be fed, but its mother's milk, or prepared food, must be given 



560 OBSTETRICS. 

with a dropper, a few drops at a time being slowly put upon the 
back of the tongue until a dram or two of nourishment has been 
taken, the amount being increased as the child grows older. 

Premature children, among the poor, often die from lack of 
care and proper appliances. With the help of the incubator 
twenty-two per cent of infants born at six months, thirty-eight 
per cent at seven, eighty-nine per cent at eight, and ninety-five 
per cent at eight and a half months have been saved. 



DISEASES OF WOMEN. 

By Ida C. Barnes, B.A., M.D. 

CHAPTER I. 

HEREDITY. 

To begin life well, means to be born of healthy parents, not 
necessarily those of high mental endowments, but of strong bodies. 
Often with healthy systematic growth, there has come at the 
proper stage of maturity great mental power that could not have 
been foreseen, and never could have developed, had the child by 
adverse circumstances become weak and imperfect physically. 
On the other hand, the so-called great men and women are often 
so weakened by excessive and unwisely directed labor that their 
children succeed only to their frailties and never rise above the 
commonplace ; and so, too, the athlete, having injured his body 
by overexertion, may transmit to his child a tendency to weakness 
instead of strength. 

Science requires that only the healthy woman shall rear chil- 
dren, but society ignores the demand, and all that can be done for 
the present generation lies along the lines of hygiene, careful 
nursing, physical culture and such education as shall give a proper 
knowledge of self, and self-control, without which more than ac- 
cidental excellence can never be transmitted to those to come. 
It is surprising what changes can be wrought in the physical frame, 
for, by intelligent cooperation and carefully and constantly fol- 
lowing rules obtained from a competent guide, unfortunate heredi- 
tary deficiencies may be largely overcome, though it must often 
be at great cost of time and sadly limited achievements in life's 
chosen field. The child can be made better or worse than the 
parent, according to the care and training bestowed. 

DIET. 

Beginning then at. birth, proper food is the primary neces- 
sity, and its kinds rank as follows: (i) The mother's milk; (2) 
The milk of a properly chosen wet nurse ; (3) Cows' milk so modi- 
36 561 



562 DISEASES OF WOMEN. 

fied as to correspond as nearly as possible with the mother's milk. 
The child's desire alone should limit the quantity of proper food. 
Girls must never be restricted in diet to make them delicate. 
Children will seldom eat too, much, unless there be too long a time 
between meals. Food should be taken at frequent and regular 
intervals, and, after the second year, both meats and vegetables 
should be abundantly supplied, and only those articles excluded 
which are known to be harmful. At puberty the diet of a strong, 
healthy girl will not need to be changed much, time and atten- 
tion being given to mastication and digestion, but if there be any 
lack of development a diet adapted to the case must be rigidly 
enforced, and more frequent, smaller meals may be an advantage. 
A school girl who does not enjoy her food will not enjoy her 
studies, and unless she eats a fairly good breakfast ought not to 
be allowed to go to school. An ambitious scholar may struggle 
along for a while without food, but sooner or later will break 
down. Hurried eating must be avoided, also highly seasoned 
food and improper drinks. Ice water, soda water, and an excess- 
ive use of mineral waters, coffee and tea, are undoubtedly the 
cause of much indigestion; but warm drinks in moderate quan- 
tity, as a small amount of tea, coffee or cocoa, if not too strong, 
are not so objectionable. To an unhealthy girl of capricious ap- 
petite at breakfast, a cup of dilute coffee or tea, or coffee with a 
little lemon juice and sugar, or a cup of good cocoa, will often 
give a relish for food. When solid food cannot be taken, soft 
boiled eggs and warm oatmeal and milk make a good breakfast. 
Smoked beef, or bacon nicely prepared, will often provoke a de- 
sire for other food, but when the appetite is capricious the same 
articles of diet must not be continually presented. Hot bread 
and cakes, fried potatoes, sausage and salt fish are forbidden ; ani- 
mal food may be taken once a day ; fatty foods are generally bene- 
ficial, and sweets and ice cream as desserts are good, but pastries 
should not be allowed. This diet is outlined for young women of 
nervous temperament; those of a phlegmatic type (the stolid, 
heavy, slow and lazy) require different fare. ' They should have 
little starchy food and very little sugar, but plenty of lean meat, 
brown bread, oatmeal and fruit. Barley flour contains less starch 
than wheat flour, and is therefore better. The fluids should be 
limited in this class of cases, while large quantities of them are to 
be taken by the nervous, but principally between meals. 



DISEASES OF WOMEN. 563 

Pure air is a constant necessity to which too little attention 
is given. In the large cities and in our public schools the air is 
always contaminated. By proper attention to ventilation, at fre- 
quent intervals, if it cannot be continuous, the air in the rooms 
can be greatly improved, and in the erection of all new school 
buildings ventilation should be made as easy and perfect as pos- 
sible. Sleeping rooms should always have fresh air coming into 
them, and sitting rooms and parlors must also be ventilated, or 
young girls kept out doors more. Wherever plumbing is used it 
should, of course, be of the best, and no sewer connection should 
ever be allowed in a sleeping or living room. To unhealthy sur- 
roundings in early life, quite as much, perhaps, as to heredity, are 
due premature decay, disease and death. The influence of bad 
air is usually soon seen in adults, but in the young it is not 
quickly apparent, although more permanent and disastrous re- 
sults may follow. 

CLOTHING. 

The clothing of women should secure an equable temper- 
ature, and for that purpose should equally cover all portions of 
the body. There is no excuse for wrapping the trunk excess- 
ively in heavy materials and leaving the legs and arms bare, or 
practically so. The corset is best superseded by a waist to which 
ail skirts are buttoned, that by carrying their weight on the shoul- 
ders there may be no pressure upon the contents of the abdom- 
inal cavity. It should be borne in mind that corsets or waists 
that are slightly tight when put on are injurious, although they 
may soon become loose under constant pressure, so flexible are 
the tissues under long-continued stress. It is this constriction 
of the waist which prevents proper expansion/ of the ribs, over- 
comes deep natural abdominal breathing, and gives rise to the 
chest breathing said to be characteristic of women. Again, what- 
ever prevents a free movement of the diaphragm hinders the cir- 
culation in the pelvic organs and harm comes thereby. Tight 
lacing, whether from corsets, straps or belts, gives rise to displace- 
ment of all the abdominal organs — liver, intestines, kidneys and 
uterus. It also tends to make thick walls and to cause large, 
protuberant abdomens. Of a large number examined by a promi- 
nent investigator, falling of the uterus was found in every case of 
tight lacing, not always extensive, but existing to some degree, 



564 DISEASES OF WOMEN. 

and there were all varieties of displacement, backward and for- 
ward, as well as downward. There have been cases in which the 
position of the stomach was so changed by lacing as to provoke 
permanent dyspepsia. 

Another argument in favor of loose clothing for a young 
growing girl arises from the fact that, in proportion to her body, 
her liver is twice the size of that of the mature woman, holds one- 
fourth of her blood, and cannot be placed under pressure without 
inviting serious consequences. There should be free movement, 
free breathing and free capacity for outdoor exercise or work in 
the gymnasium. In order to secure this there must be no com- 
pression of the feet by tight shoes nor lack of balance from high 
heels. A girl has but a short time for development and must not 
be hampered, or deformities will result that cannot be corrected. 
It is well thought that many of the irregularities of development 
are due to carelessness, or ignorant neglect of health during the 
two or three years immediately preceding puberty, by which suf- 
fering and deprivation are entailed for years to come. This state- 
ment is not intended to dwarf the importance of steady develop- 
ment from early childhood, but to secure better hygienic sur- 
roundings, while the girl is merging into womanhood, and is 
likely to neglect physical exercise because of other crowding du- 
ties or the mistaken idea that society demands quiet indoor oc- 
cupations. 

SEXUAL DEVELOPMENT. 

With the sudden secondary development of the sexual or- 
gans and the change in size and shape of the pelvis in girls just 
preceding the beginning of menstruation, there comes a change in 
mental aspirations, and a sexual instinct, which until now has 
been dormant. If for any reason the physical development up to 
this time has been retarded, it may very seriously, affect the sec- 
ondary development of the sexual organs and give rise to many 
of the ills of later life, which make semi-invalids of women. When 
there is great lack or total absence of development of these organs 
there is a' corresponding lack of development in the entire body, 
and lack of sexual instinct. Such individuals are neutral in type 
and instinct, and incapable of the highest attainment either physi- 
cal or mental. This class includes very few, but, unfortunately, 
the other class — rhose of defectively developed sexual organiza- 
tion — is so large as to include many women, all of whom are suf- 



DISEASES OF WOMEN. 565 

ferers to a greater or less degree. This is the more to be regretted 
because "so much of it could have been avoided by early care. 

At what age girls should be informed concerning the men- 
strual epoch is not easily decided, since some will menstruate at 
ten years, others not until several years later. We should, how- 
ever, make it a rule to inform a child at least a year before her 
first menstruation, which time, of course, depends upon her gen- 
eral development, the symptoms often being present many months 
before. So great is the danger from taking cold at this time, and 
from mental shock, this important crisis in a girl's life must not 
be overlooked. Girls should be informed earlier, too, than at 
first may seem necessary, for another reason and that is, if al- 
lowed to remain in ignorance too lone, - , thev will be enlightened 
by some rude companion in the most sensational manner, rather 
than by the careful and interested mother, teacher, or physician, 
who will so explain the laws of nature as to show the function a 
wise and indispensable provision by the all-wise architect ; thus 
preventing shock and the unrest which comes at this time to so 
many girls. 

The time at which a girl should be informed of the higher 
social relations likely to come to her sooner or later must also be 
left to the guardian and circumstances; but certainly a young 
woman should not be allowed to ignorantly transgress the rules of 
propriety, as so many do, when a little explanation concerning 
the manner in which her forwardness and indiscretion will be trans- 
lated by onlookers of both sexes, would serve to place her on her 
guard as to her own protection and reputation. Incidentally it 
may be said that it is just as wrong for a man to take a liberty 
as it is for a woman to allow one, but two wrongs do not make a 
right. 

Every woman before entering the bonds of matrimony ought 
to understand what her duties and privileges will be in the new 
sphere, and to accept its pleasures and burdens with joy and hope, 
otherwise disenchantments, disillusions and dissensions will often 
mar what might have been a happy home. It is certainly the duty 
of parents and guardians of young women to properly train them 
for their greatest work in life. 

At the first appearance of her menses the girl must be pro- 
tected from sudden changes of weather, exposure to cold or ex- 
hausting heat, sea voyages and changes of climate, except to a more 



566 DISEASES OF WOMEN. 

favorable one, great nervous excitement, extreme muscular exer- 
tion, exposure to contagion of any kind, and from indiscretions 
of diet that can result in indigestion. The overfed, sluggish girl 
should have exercise, the book-worm should take fresh air, sun- 
shine and mild exercise, while the overworked girl of active tem- 
perament needs rest. If these rules be disregarded at puberty 
there will be danger of arresting the development of the sexual 
organs and deranging their functions, thus impairing future 
health and usefulness. As the general development is nearing 
completion, it is absolutely necessary that the sexual organs take 
up their function promptly and perfectly. Those in whom this is 
not done are apt to be delicate and sterile. Many of the incurable 
diseases peculiar to women are due to defective development. 
The well developed woman, though liable to accidents and dis- 
ease, is able to resist the causes of disease and to recuperate from 
the injuries of accident. 

MENTAL DEVELOPMENT. 

Precocious mental development, not usually in any special 
direction, but in the acquisition, through association with their 
elders, of a conglomeration of unconnected facts forming a fund 
of general information, is characteristic of the children of to-day. 
They also possess a facility beyond their years of acquiring knowl- 
edge, but, as should be expected, lack the permanence which 
comes of gradual development. A slower mental growth, cor- 
responding more uniformly with their physical development, and 
not acquired at the expense of the latter, is more likely to usher 
in the larger life replete with usefulness in maturer years. 

Too often the emotional nature is cultivated to the neglect of 
the judgment and the spirit of contentment, and longings for 
ease and pleasure inculcated at the expense of higher motives and 
desire to accomplish great and beneficent deeds. All these things 
tend to the degeneration of correct ideals and to a womanhood 
of discontent which is a prominent cause of the nervous condi- 
tions into which so many women drift, even in their younger 
days. There is no question but that a right appreciation of cir- 
cumstances and surroundings does much to secure one's general 
good. 

Unfortunately, competition has crept into our public schools, 
and children are pushed to the limit of their ability for a few years, 



DISEASES OF WOMEN. 567 

only to finally dwarf their capacity and make of them mediocre 
women. The object m school life should be to acquire a love for 
learning and the power of systematic mental concentration, rather 
than to gam an accumulation of facts soon to be forgotten. The 
school that does not arouse a desire for knowledge is a failure. 
Each girl should be studied by her parents or guardian with spe- 
cial reference to her abilities and deficiences, and given just that 
course of study and that amount of exercise or work which will 
secure the best possible development of all her powers through 
a long life, and physical health must be regarded as the basis, for 
without it the highest accomplishments can be of no avail. Any 
course of study that exhausts the pupil and threatens physical 
disability is detrimental and should be abandoned. 

MENSTRUATION. 

The conditions necessary for normal menstruation are a good 
general development of the individual, as well as of her organs of 
generation. There must be freedom from marked organic disease, 
and an abundant supply of nutrient materials, and there should 
be agreeable surroundings. Dependent upon so many conditions, 
menstruation when properly performed indicates fair health of the 
individual, and with derangement of the function some disease or 
bad surroundings are usually discoverable. 

Menstruation is governed by the following laws, which aid 
in determining whether the individual is physically well : (i) Men- 
struation should be established when the general organization 
has attained its growth and the sexual organs have undergone 
their secondary development or are maturing. (2) The func- 
tion should occur regularly and periodically about every twenty- 
eight days and mould continue from four to eight days, until the 
change in life, excepting during pregnancy and lactation. The 
flow should be free, without clots, and contain the remains of the 
exfoliated mucous membrane of the uterus. 

Incidentally, it may be stated in this connection that an 
erroneous impression prevails among a large class of women, that 
the danger of taking cold at this time forbids usual cleanliness, 
lest a warm sponge bath, or the bathing of the external genitals 
with warm water, may result in a diminished or suppressed flow. 
That just the contrary plan gives best results cannot be denied. 
The external genitals should be washed with warm water as 



568 DISEASES OF WOMEN. 

often as the napkin is changed, which should be at least twice 
daily, and oftener if required. After a warm sponge bath pre- 
cautions must, of course, be taken to get a good reaction, and 
for a few hours to avoid exposure. Cold baths, in many cases, 
will cause suppression and, therefore, should not be taken at this 
time. 

While, as already said, uniformity exists, there is great varia- 
tion within the confines of health as to menstruation. The time 
of its first appearance is modified by climate, heredity, surround- 
ings, hygiene, health and disease. Each indvidual is also a law 
unto herself in regard to the time of recurrence, duration, quan- 
tity and character of the flow, but when certain rules are once 
established they should continue regularly during good health, 
and any marked deviation is an indication of some defect which 
must be remedied. Derangements of menstruation are usually 
due to defective development of the generative organs. 

PREMATURE MENSTRUATION. 

This term is applied to the appearance of the menstrual flow 
before the general development is completed — a condition deter- 
mined by the girl's general appearance, which indicates immaturity, 
also a lack of development of the breasts, the pelvis and the ex- 
ternal generative organs. The flow in these cases may be scanty 
or profuse, but is usually painful and irregular. It is apt to occur 
in young girls, among both rich and poor, who are illy cared for, 
and those exposed to immoral surroundings, or associated with 
older people of not the best character. The treatment consists 
in building up the general health. If in school, the girl should 
be taken out for a time and given outdoor life with plenty of ex- 
ercise and little excitement. 

Another class, presenting some of the same characteristics, 
consists of those girls in which there is a true development of the 
sexual organs before the general development is complete. Here 
again the menstrual epoch is irregular and painful, scanty or pro- 
fuse. Heredity is a factor in premature menstruation, so also is 
over excitabilit}' of the brain and nervous system. It may also be 
induced by the excitement of masturbation. The treatment is the 
removal of all exciting causes, rest and pleasant mental occupa- 
tion at home. The plan is to give nature an opportunity to com- 
plete the physical development before menstruation is regularly 



DISEASES OF WOMEN. 569 

commenced. Premature development of the sexual organs is 
abnormal only because the condition precedes the proper develop- 
ment of the general organization. 

RETARDED PUBERTY WITH PARTIAL DEVELOPMENT OF THE 

SEXUAL ORGANS. 

Cases are not rare in which there is a good general develop- 
ment and good health, but at the proper age there is no appear- 
ance of the menses. Time must be allowed for the difference m 
climates. The girl in the tropics menstruates three years earlier 
than her sister in the arctic regions. Hard physical or mental 
labor may cut oil nutrition from the generative organs, and this 
is especially true in a quiet' country life. There are also a few in 
whom the demand for general development supersedes that of 
any special organ, and this class of persons will be found to be 
well nourished. The treatment lies in rest and a change of en- 
vironment that social privileges may be enjoyed. If hereditary 
characteristics be a factor the greatest effort must be made to cor- 
rect these tendencies by suitable surroundings and the most pleas- 
ant social advantages attainable. Again, nutrition may be so in- 
sufficient, the circulatory apparatus so small, the brain and nerv- 
ous system so predominate, or the general organization be so 
imperfect or unbalanced, as to prevent functional activity in the 
generative organs. Retarded puberty is seen most markedly in 
those in whom the uterus and ovaries are absent or rudimentary. 
Usually the entire physical development is defective, so far at 
least that the girl is undersize, but in some cases the defect is in 
the generative organs only. The pelvis usually fails to broaden 
and the hips remain of the masculine type. 

An individual minus internal ^generative organs is a neutral, 
possessing the characteristics of neither sex, and, of course, is not 
amenable to treatment. 

MALFORMATION OF THE ORGANS. 

As has been said, the ovaries are necessary to menstruation, 
and any defect in them will derange this function. When they 
are absent nothing can be clone. There are cases in which they 
are imperfect, and menstruation comes only at long intervals, 
and then only in small quantity. If these cases are seen early they 
may be partially relieved by measures recommended in delayed 



570 ' DISEASES OF WOMEN. 

puberty; but they usually come to the physician too late to get 
much help. 

Malformations of the uterus are also causes of menstrual de- 
rangement, and originate at some stage in its development — in 
the embryo, or at puberty. They may be so extensive that there 
is no possibility of menstruation, although the ovaries are intact. 
Much can be done by the physician in charge to ameliorate the 
disagreeable symptoms attending these cases; fortunately the 
condition is rare. 

The forms of incomplete development which result in the 
small or infantile uterus and the flexed uterus (one unnaturally 
bent upon itself) are usually attended by difficult and painful 
menstruation in the beginning, at puberty, or soon after. The 
menstruation is generally irregular with long intervals between 
the periods, and the flow scanty and of short duration. The 
pain is acute and colicky, comes and goes, and is usually relieved 
as soon as the flow is free. If this be kept up for years, sooner or 
later there will be backache, pelvic tenesmus, occasional leucor- 
rhea, and nervous disturbances in the form of headache, irritabil- 
ity and weakness of the nervous system as shown by easily induced 
fatigue, and the digestive organs are usually impaired. 

If attention be given to this class of cases when they first be- 
gin to menstruate, much can be done to aid in a better develop- 
ment, by treatment for the imperfect and painful menstrual func- 
tion. This must be done through the general nutrition. If the 
appetite is poor, and insufficient food is taken, every means should 
be tried to make the stomach do its duty. Tonics, laxatives and 
appetizers are indicated, and when the general nutrition is fairly 
good, muscular exercise should be given with the hope of stimu- 
lating the uterine muscles, after which apply the postural treat- 
ment. See page 583. For the difficult and painful menstruation of 
patients who are otherwise strong give ten grains of the bromide 
of soda and three to five grains of antipyrine in a teaspoonful of 
mint or cherry laurel water, once in two, three or four hours; 
but those who are debilitated are often made worse by this pre- 
scription, and for them a diffusive stimulant is better, as follows: 

Aromatic spirits of ammonia thirty drops 

Chloric ether .five drops 

Tincture Cannabis indica five drops 



DISEASES OF WOMEN. 571 

Give it in syrup of acacia with some aromatic, as cardamon 
or mint, every three or four hours, according to the severity of 
the suffering. Belladonna, in doses of the same size, may be sub- 
stituted for the cannabis indica, if the latter does not do well. 
There are many other prescriptions which can be used, but un- 
der a physician's direction. 

CHLOROSIS. 

Chlorotic girls mature slowly and menstruate late. Chloro- 
sis is a condition in which the blood vessels are imperfectly de- 
veloped. The aorta is small and thin-walled ; there is often fatty 
degeneration of [he walls of the arteries; the ovaries and uterus 
are small ; and the heart and sexual organs may show degenera- 
tion. There is usually anemia, and poor muscular and bone de- 
velopment, bur a tendency to plumpness with abundant adipose 
tissue. The face is putty, the mucous membranes are pale, and 
the countenance waxy, yellow or green. Menstruation occurs 
later than usual and is likely to be scanty. The disease is heredi- 
tary, and usually manifests itself in infancy, but rarely attracts 
attention until the beginning of puberty, when the anemia begins 
to show itself. Although hereditary, chlorosis is greatly aggra- 
vated by bad surroundings and insufficient food and exercise. 
These girls dislike an active life and incline to inactivity of the 
body, although they may be mentally bright. The treatment 
consists in a large amount of physical exercise, which should be 
of a nature to produce more bone and muscle, and not fatty tis- 
sue. Sluggish action of the bowels and kidneys should be cor- 
rected, and some form of iron should be given to favor blood 
formation. In cases that are not seen until late in the disease 
and are much enfeebled, it may be necessary to give massage and 
rest in Ded until the nutrition is so far improved that light exer- 
cise may be taken. When menstruation has become regular and 
the appetite has improved under careful attention, these patients 
often become much better. The cold bath and cold pack have 
been advocated, but more benefit is obtained from a sponge bath, 
of temperature agreeable to the patient, to keep the skin active, 
than from severer methods. If necessary the cold bath may be 
used later for its tonic effects. The treatment should be con- 
tinued even after the more prominent symptoms have disappeared. 



CHAPTER II. 

THE ACTIVE PERIOD OF LIFE. ITS CHARACTERIS- 
TICS AND DISEASES. 

To understand how to treat woman during that period when 
she must bear the strain and burden of her life, it is necessary 
to consider her personal characteristics. If we believe that nerve 
influence is the most potent factor in securing normal work from 
cells and their protoplasm, it is easy to see how the extreme sen- 
sitiveness of woman's nervous system may be made a force in 
promoting the highest functional activity, or, if allowed to run 
riot, may so interfere with the normal mechanism of the body as 
to favor continued disease. 

Since anatomy and physiology have become the basis of sur- 
gery and medicine, the surgeon paying particular attention to the 
former, the physician to the latter, we find that both are equally 
dependent, the one upon the other, and that it is impossible to 
properly treat the diseases of women without considering the 
physiology and functions directly bearing upon each case. Great 
advances are being made in the practice of medicine, not so much 
in the discovery of new remedies as in new combinations of rem- 
edies and new methods of managing disease. Less medicine is 
given and more attention is paid to hygiene. Patients are in- 
formed that they must just as carefully follow the directions of the 
doctor in regard to sanitation, diet, rest and exercise, as in taking 
medicines in the right quantity and at the right time, and that 
they must give sufficient attention each day to the accomplish- 
ment of these ends. We think there can be no more valuable 
service rendered in the majority of cases than to convince the 
patient that each individual must be a law unto herself, with self- 
limitations, and that the highest art is in acquiring the ability to 
accomplish the most possible, in any line, consistent with her own 
good health — not the good health of some other woman. Were 
this rule followed there would be fewer cases of nervous prostra- 
tion and fewer premature deaths. 

572 



DISEASES OF WOMEN. 573 

CONTRASTS IN MASCULINE AND FEMININE DEVELOPMENT. 

As compared with men the bones of women are smaller and 
less abundantly furnished with lines and processes for the attach- 
ment of muscles; the bones of the pelvis, though larger, are 
smoother and not as strong as in man, and the arch in front is tri- 
angular, and while the cavity is not as deep as in the male pelvis, 
there is more room in the pelvic cavity. The muscles, although 
smaller than in men, are not as inferior in quality as might be sup- 
posed, It has been claimed that women are less sensitive to pain, 
but this probably only means that their endurance is greater, and 
that they learn to bear it because of the functions which make 
it a necessity; they certainly possess greater mental and moral 
sensitiveness. It is found that tissue changes, as far as disintegra- 
tion is concerned, proceed more slowly in women than in men, 
that they recover sooner from shock and strain, and although they 
require more sleep, they are able to endure the loss of sleep for 
longer intervals without breaking down. 

THE FEMININE BRAIN AND NERVOUS SYSTEM. 

Whether the brain and nervous system of woman differs 
from that of man has been a subject of much discussion. The 
development of the brain is shown, not by weight or size, but by 
its number of convolutions or folds, the infantile brain sur- 
face being comparatively smooth, but, as its mental faculties de- 
velop, the sulci appear, shallow at first, but growing deeper and 
deeper as the years of experience are added. The anatomist has 
found very little difference in this respect, either in the brains or in 
the sympathetic nervous systems, of men and women, except 
that the ganglia and their connecting nerve filaments are larger 
in the pelvic organs of women, and as this nerve supply is most 
intimately connected with the process of nutrition, which is so 
active during pregnancy and lactation, it is reasonable to sup- 
pose that a higher development of this nerve force in woman al- 
ways exists. 

As to nervous affections, there is this peculiarity : Women, 
being more emotional than men, are more liable to functional 
nervous derangements ; but men are more prone to nerve diseases 
based upon real organic lesions, and far more men than women 
die insane. 



574 ' DISEASES OF WOMEN. 

WOMAN'S RECUPERATIVE POWER. 

It is well known that woman recuperates more quickly than 
man, that she produces blood more rapidly after hemorrhage, 
and that after exhaustion she regains her former standard sooner, 
also that her nutrition is maintained longer and with greater 
activity, and that, although woman is rendered liable to many and 
peculiar diseases by the higher development of her sexual organs, 
and the greater and special functional activity to which they are 
subject, her greater recuperative power and immunity from various 
other maladies give her a longer average life than that allotted 
to man. This law is said to also hold in the lower animals and 
plants. Dr. Ough asserts that from two to six per cent more boys 
than girls are born, but that there are six per cent more women 
than men. Although not possessed of as great strength, woman 
endures pain longer and lives where man -succumbs. Of course, 
great loss of life results from war, but more men than women 
die from fevers and contagious diseases in times of peace. 

THE SEXUAL INSTINCT. 

The sexual instinct is born at puberty — the period of 
full development of the sexual organs. This instinct is not 
nearly as strong in women as in men, and many women, before 
marriage, are entirely destitute of the sexual desire. This is not 
a bar to fruitfulness ; indeed, the most passionate of women have 
been barren. This appetite is lessened by menstruation, and is 
diminished by lactation, as well as by pregnancy; it usually also 
grows less as the change in life approaches, but there are striking 
exceptions. In the earlier days men and women were polyga- 
mous, but woman has always been monogamous in disposition, 
and man is becoming more so — a result of civilization which is 
ever approaching the ideal. 

THE DANGER FROM UNCONTROLLED PASSIONS. 

We must admit that the sexual instinct, uninstructed and 
uncontrolled, leads astray, else why so many prostitutes, divorces 
and unhappy homes? Let a pure and proper knowledge of the 
reproductive organs and their functions be early imparted to the 
children by the parents, and, as they would shield their boy and 
girl from deadly disease by keeping contagion far away, so let 
them ever be alert for moral lepers, young and old, lest by con- 



DISEASES OF WOMEN. 575 

tact with them their lives be as truly poisoned as were deadly 
drugs administered in sufficient doses to gradually but ultimately 
detroy them. By early and correct training, direct and indirect, 
the mind while plastic and pure can be so imbued with the proper 
estimation of the sexual relation as to prove a sure deliverance to 
both sexes in unprotected years to come; and, until the age of 
understanding and responsibility is reached by each individual, 
parents, guardians and teachers are more to be blamed for most 
of the transgressions of the moral law than the offenders them- 
selves. For the adult man or woman who would designedly 
and seductively lead a young life astray there are no words of 
condemnation strong enough. 

It must not be forgotten that the impure and immoral is 
more apt to reach the average girl through the books she reads 
than through bad companions, and that the latter often follow 
as a result of the former. It is much to be lamented that many 
of the popular books of the day portray characters that belong 
not to the society of an innocent girl, and are of such a tone as, 
by their perusal, to make even older people feel guilty of having 
descended to the companionship of the debased. 

NATURAL AND SEXUAL SELECTION. 

Natural selection enables individuals to select the surround- 
ings most suitable to their individual growth and, of course, has 
its influence upon the characteristics of sex — some perversions of 
natural selection being detrimental to sexual selection by develop- 
ing peculiarities of sex. Sexual selection develops characteristics 
which enable animals to live. In considering it, all the features 
which favor reproduction must be included. It has been said that 
woman, because of her less defined sexual instinct, is less capable 
of selecting, but when to that is added the maternal instinct, with 
which she is so fully credited, it remains to be determined whether 
she could not select a better lather for her children than often 
falls to the lot of woman, compelled to choose from the number 
offering themselves. There is a long list of qualifications which, 
in both sexes, should supplement the sexual instinct. Reproduc- 
tion, alone, only brings added responsiblities and demands for 
strength to bear the burdens of training and support. Unless 
the animal instinct is based upon the higher quality of love, which 
makes each willing to yield much for the pleasure and comfort of 



576 - DISEASES OF WOMEN. 

the other, there will not be that peace and happiness which ought 
to rule in every home. 

The great question as to woman's place in the world would 
be almost wholly solved were every individual boy and girl taught 
to be self-supporting, and to this training were added the further 
teaching that the highest physical function of man and woman 
is the production of a healthy child of true proportions and un- 
clouded mind, it being understood, of course, that in the majority 
of cases a woman who assumes the responsibilties of home-keep- 
ing is to be exempt from other trades. To properly keep a home 
is a large enough vocation for the average woman, who should 
at the same time gain recreation from the outside world, and 
keep in touch with her husband's business and her country's wel- 
fare. She ought to be an independent thinker, and follow some 
line of research. Then will her children inherit from both father 
and mother the abilities and talents for which all parents watch so 
eagerly as the young lives unfold. 

Efforts to thwart nature's plans are always dangerous, often 
exceedingly injurious. The child-bearing period should be early 
in the married life. Devices for preventing conception often so 
reduce or injure one or both parties that, later, when children are 
greatly desired, the would-be parents are unable to beget them, 
or, at most, are able to produce but a weak and enfeebled 
progeny. 

RELATION OF THE SEXES. . 

We are indebted to Dr. J. R. Scott of Clay Center, Kan., for 
permission to quote the following from a paper read by him at 
Denver last December, before the convention of the Western 
Surgical and Gynecological Association, and printed in their an- 
nual report : 

"A large number of women, as far as my observation ex- 
tends, believe that man in his sexual life is an animal, whose pas- 
sions must be gratified at all times and under all conditions, re- 
gardless of the wife's likes or dislikes. I blush for my sex when 
I say that a large number of men share in and act upon this be- 
lief. I readily admit that man's passion is the more readily 
aroused and the more active. The male is the aggressor, always, 
in all relations of the sexes. Women would hate and despise a 
creature fashioned in the likeness of man without his attributes 



DISEASES OF WOMEN. 577 

— aggression, force and power, call them what you will — the 
qualities of manliness ; but were the male mind not wrongly edu- 
cated, no such idea as I have stated would prevail. From early 
boyhood the male, from his surroundings, and later by associa- 
tion with men, impure in thought if not in practice, becomes 
impregnated with an idea of woman's sexual life which prevails 
only among women of the town. He therefore grows up believ- 
ing that women are sensual to an unwarranted degree, and the 
sexual act, which should be looked upon by him as pure and 
right, is associated with the baser side of his nature. I hold, and 
this applies to both sexes, that not one of nature's laws can be 
broken without disastrous results, near or remote. Hence, when 
the sexual act is indulged to gratify the animal in man, stimulated 
perhaps to a greater activity by drugs, without mutual attraction 
and the ready acceptance of the possible results of such an act, 
the individual moral tone is lowered. Particularly is this the 
case when one or both the parties to the act indulge with the de- 
liberate intention of avoiding natural consequences. It is then on 
a level with drunkenness and gluttony. A man or woman might 
better cheat, lie or steal ; for a reaction will come that will be as 
disastrous to a person with moral instincts as that following in- 
dulgence in masturbation, and we have all seen its bad effects 
upon both mind and body. We know how unhappy the lives of 
women are who rind no enjoyment in the sexual act, and who 
acquiesce only from a sense of duty. Many such wives are the 
subjects of melancholy, and their physical health is as poor as 
their mental condition. 

"Then, too, there is the class whose passions are awakened but 
never satisfied because of the rapidity with which the male reaches 
the climax. These are all cases in which mankind have a right to 
expect the conservator of health to give instruction, and to also 
be a conservator of peace of mind and of morality. Do we, as 
physicians, do our full duty in this respect? Do we take the 
same serious view of a broken natural law that the iegal frater- 
nity take of statutory infraction ; or that the moralist does of out- 
raged morals? 

"A doctor should not countenance the idea that it is neces- 
sary for young men to sow wild oats. A large percentage of 
women's diseases are results of specific infection. Sowing wild 
oats is a most prolific means of spreading venereal diseases. Many 



578 DISEASES OF WOMEN. 

a woman has borne months of suffering and undergone surgical 
operations because of her husband's carrying in his person infec- 
tion acquired while sowing wild oats. It is a doctor's place to 
relieve suffering in saint and sinner; but he must also prevent 
disease by every possible means. I also believe that everyone, 
suffering from venereal disease, who goes into a doctor's office 
should go out feeling safe from exposure, but also feeling that he 
has committed such a crime against society that exposure could 
add nothing to his disgrace. 

"I believe that as morals are improved by moral suasion, and 
by education along sexual lines, that by pointing out to every 
infected young man who conies to us that he has committed a 
crime against the honor of man and the virtue of woman, the per 
cent of pelvic diseases will be perceptibly lowered. Venereal dis- 
eases should be dealt with as are other contagious diseases, but 
the relation of the doctor to the patient prevents quarantine, iso- 
lation and danger signals. Silence is a duty we owe those who 
entrust us with their secrets, but we also owe a duty to the in- 
nocent who may suffer from our patient's moral deflection and its 
very unpleasant but to be expected results. We shut our eyes 
too much to the consequences of these very prevalent diseases 
in young men until confronted with a case of pelvic trouble un- 
doubtedly due to specific infection. We then denounce the 
man in our heart, when he should have been read a moral lecture 
in the office of the doctor who cured (?) him. . . . This 
phase of the subject belongs rightly to the field of preventive medi- 
cine, hence comes fairly under the subject chosen. Had we 
physicians, as a class, the moral stamina which we should have, 
we could limit very materially this form of moral obliquity, and 
its attendant evils, thereby effectually preventing diseases which 
we can only imperfectly cure." 



CHAPTER III. 

GENERAL MEANS EMPLOYED. 

We will describe some of the simple methods used in the 
treatment of women's diseases and their application to them alone, 
that when mentioned in connection with the cure of any special 
condition there may be no misunderstanding. 

HYDROPATHY. 

The use of water in various ways has in recent years acquired 
a large place in the treatment of disease. Its benign effects in 
the management of fevers have long been known, but the discovery 
of its value in the treatment of nervous disorders is more recent. 
For our purposes, water will be considered principally as used for 
baths, hot and cold, and for douches. The direct result of a bath 
is a shock to the cutaneous nervous system. "When it is remem- 
bered how extensively the surface is supplied with sensory nerves 
one can easily understand that a great impression can be made 
upon the nerve centers by direct applications to the skin. 

The effects of water vary with its temperature and the mode 
of its application. To the cutaneous nerves, water is either stimu- 
lating or sedative and, secondarily, either a sedative or tonic to the 
nerve centers. Action and reaction are obtained. Mild stimula- 
tion may be followed by a sedative effect and, vice versa, a sedative 
effect may bring on stimulation. Its action upon the circulation is 
of the same order; the circulation may be equalized by the primary 
effect of a warm bath which stimulates the capillary circulation and 
invites the warm blood from the deeper structures ; while the cold 
bath, by lowering the surface circulation, drives the blood to the 
deeper structures, and puts more work upon the heart. When 
the reaction comes the effect of the warm bath is found to be just 
the opposite of that of the cold one. This change in the circula- 
tion is not all mechanical and is a real help in the process of blood 
making, probably due to the tonic and enervating effects of the 
cold bath. 

579 



580 DISEASES OF WOMEN. 

The first indication for the use of water in nervous diseases 
is the need of its quieting effect. For this the warm or hot pack 
will be found most serviceable, when the patient is too weak or 
too irritable to take an ordinary bath. To relieve wakefulness 
and secure undisturbed sleep it is usually better given at bed time 
before taking the last nourishment or dose, of medicine, but should 
it excite the patient and drive away sleep it must be taken earlier 
in the day. After the bath, administer either brisk or gentle 
rubbing, whichever the patient will tolerate best, and if this does 
not produce the quieting effect, rub her with the following oint- 
ment : 

Chloral hydrate one dram 

Camphor one dram 

Rosewater ointment four ounces 

To give the bath, wrap the patient in a heavy woolen blanket 
wrung from water at a temperature of 1 10 degrees Fahrenheit, and 
place over this a large dry blanket and rubber sheet. She may be al- 
lowed to remain in this bath from thirty minutes to two hours. 
The small blood vessels of the skin are at once widely dilated, the 
internal blood vessels are relieved of pressure, the excretions from 
the skin are excited, and the general relaxation, known as a seda- 
tive effect, follows. 

As soon as the patient can endure the tonic effect of the cold 
bath, a linen sheet may be used wrung from cold water of a 
temperature of 70 to 50 degrees; better to commence with the 
former and work down to the latter. Wrap the patient in this 
sheet, and wrap the head with a wet towel ; over the wet sheet 
wrap a dry one, and the rubber blanket over all. At first there 
is constriction of the small blood vessels of the skin. This lasts 
but for a moment, and is then followed by a flow of blood to the 
entire surface ; not much heat can be given off because of the 
blanket, and there is not as much perspiration as by the warm bath. 
The cold bath is tonic in its action, and is of much value in general 
restorative treatment. 

TURKISH BATHS. 

Turkish Baths are very effective in the treatment of rheu- 
matism and plethora, but are seldom well borne by patients who 
are nervously depressed. Persons with inactive skins and slug- 



DISEASES OF WOMEN. 581 

gish elimination are benefited by an occasional Turkish bath, 
especially in the change from a hot summer to a cold winter, when 
the perspiration suddenly ceases and much work is thrown on the 
kidneys. These baths are also good to relieve kidney diseases. 
Although some can take them the year around and feel better in 
consequence, others are thereby rendered subjects of constant 
colds, and still others complain of faintness, fatigue and irritability 
following them. The two last classes are harmed rather than 
benefited by the Turkish bath. 

Could this bath be robbed of some of its drawbacks it would 
serve a better purpose. Proper ventilation is usually lacking and 
there is danger of exposure to infectious and contagious diseases. 
The attendants and rubbers are not careful in cleansing their hands, 
or in going from one patient to another, scrubbing brushes are not 
cleansed, and blankets upon which patients recline are used over 
and over again. By furnishing her own blankets and brushes the 
patient can lessen these dangers, but there will yet be liability to in- 
fection from venereal diseases ; in fact, sufferers from such troubles 
most frequent these baths. There should be a room for the sep- 
arate cleansing of those who have been exposed to contagious and 
infectious diseases, and their clothes should be disinfected. The 
Turkish bath is without doubt very valuable in many general dis- 
eases, but not noticeably so in women's diseases, unless they be 
complicated with one or more of these general disorders. 

ELECTRICITY. 

This is of great value in the treatment of the nervous 
complications accompanying and resulting from various 
forms of pelvic disease, when it takes time to reach the seat of the 
disorder ; also for the relief of pain and to stimulate the absorption 
of inflammatory products. Faradic, galvanic or static electricity 
is used according to the needs of the case and its effect upon the 
individual, one responding best to one form, another to another. 
Electrical treatment can be successfully and safely applied only by 
the physician, or under her direction, since if improperly used it 
may result in more harm than good. 

EXERCISE. 

In the management of diseases of the pelvic organs, 
and during convalescence it is often essential to employ 



582 DISEASES OF WOMEN. 

muscular exercise and, in order that the inflamed tissues shall not 
be injured, it is necessary that this exercise should be taken by the 
patient while lying on her back. The extremities can be exercised 
by first raising one leg so as to form an obtuse angle with the 
body, holding it there a minute, then slowly returning it to the bed ; 
this may be repeated several times as long as the patient does not 
become tired. Next the leg may be flexed and extended slowly in 
the same manner, but not to the point of becoming tired; then 
flex the leg upon the thigh, and the thigh upon the abdomen and 
repeat slowly. Each movement should be stopped short- of mus- 
cular fatigue. The leg is also raised straight and turned in and out 
as many times as the patient can easily stand it. The other leg is 
given similar exercise; and the arms are exercised in a similar 
way, except that both are used at the same time. They should 
first be raised to form a right angle with the body and the move- 
ment repeated several times, then raised above the head and 
brought down in a line with the body. The forearms are next 
flexed upon the arms. The hands are exercised by forcibly clos- 
ing and opening the fingers and bending the wrist in every pos- 
sible direction. In cases of active pelvic disorders, it is well to 
elevate the part of the bed upon which that portion of the body 
lies. These movements are beneficial to those who have gotten 
beyond the need of massage and, but for the local pelvic condition, 
could take active outdoor exercise. 

Some of the following exercises strengthen the muscles of the 
back, abdomen, trunk and limbs when these have become weak- 
ened by long disease or sickness. For strengthening the abdomi- 
nal muscles, Dr. Savage recommends the patient to lie on her back 
in bed, to raise the head and shoulders a few inches from the 
pillow, hold steadily a moment, then slowly drop back; this is 
repeated immediately, then an interval of rest taken and the move- 
ment repeated again; five repetitions completing the exercise, 
which must stop short of fatigue. Later the feet should be fixed 
against the footboard and the patient rise to a sitting position, then 
gradually fall back, at first reclining on the pillow, and afterward 
lying flat on the bed, going through the exercise five times. Again, 
the patient lying on her back brings the bended knee toward the 
face as far as possible without effort, then forces it toward the face 
an inch or two. This is done with the other lesr also, the exercise 



DISEASES OF WOMEN. 583 

consisting of five such movements with each leg. A more difficult 
feat is for the woman, flat on her back, to raise first one leg, then 
the other, from a horizontal to the vertical position, repeating ten 
times with each leg. Finally, the abdominal muscles are strength- 
ened by placing a weight upon the abdomen and drawing deep 
abdominal breaths to lift the weight as high as possible, holding it 
there a few seconds, then allowing the air to slowly escape from 
the lungs. 

To strengthen the muscles of the back, the woman, lying on 
her back with her feet drawn up, raises her hips until the thighs are 
in a line with her body, keeps this position a moment, then slowly 
drops back; this is repeated five or ten times. Lying prone with 
arms at her side, the woman breathes deeply, raises face and 
shoulders from the pillow, keeps this position a moment, then lets 
the head and shoulders fall back. The following is harder : The 
body is lifted off the bed four or five times, with a rest after each 
effort, the elbows and toes being the only points of support. The 
lateral muscles can be strengthened, the woman lying on her side, 
by lifting the hips and making the shoulder and lower leg the 
only points of support. It is hard to take systematic exercise alone, 
and these movements are adapted to those only who are not able to 
get outdoors. In commencing such exercise only a few move- 
ments should be taken at first, and never to the point of weariness, 
and the number noted each day, that two or three movements may 
be added daily to each exercise. Next come riding and walking, 
then some daily occupation. 

Baths should be continued all through the treatment to keep 
the skin active and clean, also for the exercise. The kind of bath 
should be suited to each case, and that most agreeable and fol- 
lowed by the best results invariably used. 

RULES FOR MUSCULAR EXERCISE FOR FAILURE OF MEN- 
STRUATION. 

We copy from Skene's "Medical Gynecology" the following 
rules for muscular exercise for failure of menstruation, in young 
girls : 

"First, with one foot forward a deep breath is drawn and the 
arms elevated above the head, parallel in front and palms facing in- 
ward ; then during expiration they are brought down laterally with 
palms facing forward. 



584 DISEASES OF WOMEN. 

"Secondly, lying on the back, the lower extremities unsup- 
ported and the legs crossed, the toes execute circles from within 
out, the movement occurring in the ankle joint. This is repeated 
reversely eight or ten times in each position. 

"A third exercise is for the patient to stand upright, with 
feet well apart, the buttocks resting against a table and arms above 
the head. The trunk is flexed en the pelvis sidewise and forward 
slowly, five times to each side, pausing after each motion. 

"A fourth, with hands on the back of a chair and one foot 
upon another chair behind her, the patient rises on the toes of the 
other foot, then drops toward the ground by bending the knees, 
then resumes the extended position on the toes, finally dropping 
on her heel as before the start. This is done slowly five times with 
each foot. 

"Fifth. The patient stands upright with feet apart and arms 
elevated, the body is bent forward, then backward, then pauses in 
an upright position. Five times each. 

"Sixth. Resting a hand upon the back of a chair before her 
and standing on the leg of the same side, the other leg is raised, 
and the knee rotated from within out ; then reverse the legs. 

"Seventh. With hands on the hips and body well back, a 
running motion is executed, but the patient remains in the same 
spot, each step bringing the thighs to a horizontal plane; ten 
times rapidly, then three or four times with an interval between 
each two. This sends a good current of blood to the pelvis. 

"Eighth. Standing with feet apart and hands on the hips, 
the head describes a circle five times in each direction. 

"Ninth. Kneeling on a cushion with knees apart, the body is 
bent backward and returned slowly to the perpendicular, five to 
seven times. 

"Tenth. This is a passive motion, the patient in a semi-re- 
cumbent position. The assistant lifts one leg by a hand in the 
popliteal space (under side of the knee joint) and another on the 
sole of the foot. The thigh is, flexed on the abdomen, carrying the 
knee outward, and describing a small circle. Repeat the motion ten 
times while increasing the rapidity of it. After a pause the assist- 
ant again commences, and thirty or forty movements are given 
to each leg, the patient being absolutely relaxed. Flexion and ex- 
tension can also be made against resistance." 



DISEASES OF WOMEN. 585 

DISCHARGES OF BLOOD BETWEEN THE REGULAR MENSTRUAL 

PERIODS. 

For this disorder the same authority gives a line of exercises 
quite as extensive : 

"First. The patient sits facing the operator, with hands on 
her hips and her knees apart. The operator puts one hand on her 
shoulder and the other under the opposite axilla, drawing her 
forward and simultaneously twisting her body in the pelvis. She 
is to resist the forward motion and the operator is to resist the 
backward motion; six times for each side. Then a direct for- 
ward and backward pull is made, the patient keeping the back 
muscles very tense. 

"Second. The patient is to kneel with her hands on her 
hips, the operator behind her, puts a knee against her and her 
hands under her armpits, she bends forward while the operator re- 
sists, then the operator draws her upward while she resists. When 
the patient bends forward her body is rapidly twisted several times 
above the pelvis. This is done live times, with a rest after each 
maneuver. 

"Third. The patient stands in a doorway, the arms vertical, 
hands against the top of the doorway, while the operator places 
one hand upon the abdomen and the other between the scapulae 
and pushes her forward. As she regains her first position the 
operator resists and pushes her hand upward, ten times. 

"Fourth. The patient stands with her back against the wall, 
her hands on her hips, and she places an ankle in the operator's 
hand while the operator steadies her by placing her other hand 
against the upper part of the hip bone of the same side; the leg 
is drawn up and out, she resisting, then the operator resists while 
she lowers the leg. This pump-handle motion is repeated five 
times for each side. 

"Fifth. The patient leans against a chair or bedpost at as 
great a slant with the floor as possible, while the operator, one hand 
under the abdomen, lifts the foot, the patient passive; then she de- 
presses the leg while the patient resists. Five times for each side. 

"Sixth. The patient leaning forward puts her hands against 
the wall, chest level, turns the elbows out and keeps the feet apart. 
The operator, one hand supporting the abdomen, taps lightly upon 
the sacral lumbar vertebrae (just below the small of the back) with 
half closed hand. 



586 DISEASES OF WOMEN. 

"Seventh. The patient draws her feet together under the 
bended knees, lifting the hips clear of the couch, the operator re- 
sisting an attempt to draw the knees together. Five times. Then 
the attempt to separate the knees is resisted. This strengthens 
the levator muscles. 

"Eighth. If the patient is incapable of performing any of 
these movements, she reaches her hands to the operator, the el- 
bows slightly bent, while her arms are moved at the shoulder 
joints in all sorts of circling motions while she is passive. She 
then bends her arms ; the operator resisting flexion, she extension/' 

SWEDISH MOVEMENTS. 

"Swedish Movements" are a branch of mechanical therapeu- 
tics devised by Ling of Sweden in the earlier part of the present 
century. A great many machines were made by which different 
groups of muscles were moved in many different ways, and if 
patients could not or would not exercise, the machines did it for 
them with equal benefit to that acquired by natural exercise. In 
diseases of women, and of those also who are nervously exhausted, 
the only claim made for this system is that it develops muscle to its 
full capacity, by which undue nervous irritability is diminished, 
and in chronic cases engorgements are relieved. Its best results 
are obtained in chronic functional disorders. The system re- 
quires very complicated apparatus, access to which can be had only 
in large sanitariums, gymnasia and institutions especially devoted 

to this work. 

MASSAGE. 

Massage is motion communicated to the tissues of the body 
from some external source. It may be transmitted directly to the 
part operated upon, or may be produced through some mechan- 
ism. Stroking, kneading, friction and percussion are the four 
principal procedures. Stroking should be performed with the 
palm of the hand and its motions should be toward the heart. 
Friction is usually performed with the tips of the fingers over small 
areas, but the thumb is far better. The skin ought not to be 
irritated in this process. Kneading is the grasping of a muscle, or 
group of muscles, by one or both hands, and rolling or squeezing 
it or them upon the parts near them. When a limb is held be- 
tween the palms a rapid to and fro movement is made, the iimb 
being rolled back and forth between the hands. When alternate 



DISEASES OF WOMEN. 587 

pressure and relaxation are made very rapidly, the kneading process 
is called vibration and requires great skill. Midway between 
kneading and percussion is pressure with the linger tips or 
knuckles. Percussion is the last distinct method in massage. The 
hand may be used, or an instrument called a percusser or muscle 
beater. In percussion the operator may employ clapping, chop- 
ping and whipping. 

A few of the applications of massage to women's diseases 
may here be considered. It may also be noted that massage fails 
of its end if not given by a thoroughly trained and experienced 
manipulator, as well as when prescribed without a correct diag- 
nosis, or when advocated as a cure-all. Abdominal massage 
is helpful only when the abdominal muscles are relaxed. If 
there are fecal accumulations, massage about the cecum and sig- 
moid flexure is best by stroking. General massage will increase 
peritoneal absorption and aid in the absorption of fluids in the 
abdomen. Rapid circular strokes over the abdomen increase the 
peristaltic action of the intestines. Functional derangements of 
the liver and spleen are much helped by massage. Stones in the 
gall bladder may be dislodged by careful manipulation. 

In functional disorders of the digestive system, and in dys- 
pepsia, massage of the abdomen is of benefit, for with its help the 
stomach does not retain food as long, and the secretions of the 
stomach and liver are stimulated. It should not be administered 
when the movements of the stomach are too great. Kneading 
the abdomen for constipation is one of the surest remedies; in 
obstinate cases vibration may be used. It is useful in the dyspep- 
sia of anemic girls, but if gastric ulcer is suspected it should not 
be employed. 

In some cases of obesity, massage and proper diet are 
very beneficial. In pelvic engorgements, and functional uterine 
troubles, massage and movements aid other treatments. One 
treatment in twenty-four hours is usually frequent enough, and it 
should be of forty to sixty minutes duration. 

DIET IN DISEASE. 

The water taken in sickness should be known to be pure; 
if it is not it should be boiled and filtered. Distilled water charged 
with carbonic acid gas is very agreeable to most patients ; and 
water may be medicated by adding cream of tartar, lemon juice, 



588 DISEASES OF WOMEN. 

or any mineral acid indicated. Alkalies or alkaline salts may be 
added and the water charged with carbonic acid to suit the taste. 
Tea and coffee, when there is sleeplessness or irritability, are to be 
taken in very small quantity, if at all, but in cases of exhaustion they 
may be used as mild stimulants. They are not restoratives but, 
in a measure, prevent waste. There are no iron-clad rules to be 
made concerning these drinks ; some persons take tea best, others 
coffee, and some can take neither. The patient should be gov- 
erned by her past experience. 

Tea elevates the bodily temperature, and, in cases of shock, 
is often better than alcoholic stimulants, since it is followed by 
no reactive depression. In women's diseases alcohol is seldom 
needed, unless after a very severe operation upon one accustomed 
to such stimulants, and it is harmful then if long continued. No 
one form will suit every case; some doing better on beer, others 
on champagne, etc. 

FLUID DIET. 

In cases of acute gastritis, the physician must consider the 
kinds of food and their purity, rather than the quantity, that shall 
be given. This is often a difficult problem, but unless solved cor- 
rectly, there may be a failure to tide the patient over to what might 
otherwise have been a favorable result. In acute cases the 
stomach first rebels, and solid food cannot be given; but milk, 
gruels, eggs in fluid, and beef extracts and juices, can usually b'e 
borne. In fevers milk is the best food, in spite of the fact that it 
will coagulate and is indigestible for some persons. Milk is often 
best brought to a boil, or even boiled and then diluted with vichy, 
apollinaris or distilled water charged with carbolic acid gas. It 
is to be given in small quantities and at frequent intervals — two 
ounces of milk in two ounces of water. Whey is milk from which the 
casein and much of the fat have been separated by coagulation 
and straining. It can be given when milk is disagreeable, and can 
be made more nutritious by adding the beaten yolk of egg or beef 
juice. 

Eggs are a complete food, as they contain all the necessary 
elements for the nutrition of the body. They may be beaten up 
with hot water, strained, and added to clear soup or broth. The 
English beat up an egg in a cup of hot tea. The Germans like 
slightly boiled eggs beaten up in hot broth, and also use eggs in 



DISEASES OF WOMEN. 589 

coffee. Beef juice, beef extracts, meat infusion, and other similar 
articles are good in fever, but may be given in a too highly con- 
centrated form, and stimulate too much. They may be diluted 
and flavored with the juice of fresh vegetables, as carrots, parsnips, 
etc. ; and these vegetable juices are a valuable addition. The pulp 
or fine scrapings of meat may be added to dilute extracts of clear 
soups, in cases of a subacute type. Calf's foot jelly, rice and bar- 
ley water, chocolate, fruit, soups, oatmeal and the like answer 
well for a change. 

Malt extracts and malted foods are only digested starches, and 
usually contain ground malt, some wheat flour, a little bicar- 
bonate of potash and milk. The salts and fats are not well repre- 
sented in these foods, hence it is necessary to add them. Pepsin, 
the ferment of gastric juice, when properly given with the food in 
acute cases, is frequently a large factor in saving life. Predigested 
foods, pancreatin and peptonized foods are very valuable, but often 
obnoxious on account of their odor and taste. Peptonized food is 
now easily made in the sick room, from extracts of pepsin and 
pancreatin. Peptonized milk and peptonized milk gruel are re- 
garded as nearly equal to peptonized beef extracts. 

FORCED FEEDING. 

It is well to describe here what is known as forced feeding. 
The patient is first put upon a milk diet, three or four ounces 
every two hours, increased in a few days to two quarts in the 
twenty-four hours, given in divided doses. In case there is con- 
stipation a mild laxative, as a two to five grain tablet of cascara 
sagrada, may be given once daily. At the end of a week a light 
breakfast is given, and soon three good meals a day are taken 
in addition to the two quarts of milk at and between meals. There 
may be added thin lean-beef soup, to which has been added five 
drops of hydrochloric acid, cocoa, a quantity of butter ; and a half 
ounce of cod-liver oil may be given after each meal. If, as a result 
of this forced feeding, diarrhea or dyspepsia occurs, give only half 
diet. The urine must be examined and when urates begin to be 
deposited return must be made to the simple milk diet or the 
quantity of food reduced. 

Another method is to introduce into the stomach an excess 
of food by an esophageal tube, it being retained and digested, 
where previously all food had been rejected, much less digested 



590 . DISEASES OF WOMEN. 

Debove, who introduced this plan, said that he found no relation- 
ship between appetite and digestive power. Powdered raw meat 
can best be given through the tube, and this is the form of invalid 
feeding now in vogue in France. 

A VEGETABLE DIET. 

A vegetable diet can be either fulLor spare. It consists prin- 
cipally of vegetables, fruits, milk and eggs ; unless a very low diet 
is demanded to obtain a degree of starvation, m which case vege- 
tables alone are used. Although this gives sufficient bulk, it is a 
tax upon the organs of digestion. When there is more than nor- 
mal sexual excitement, the vegetable diet answers well because 
non-stimulating and the stomach irritability detracts from the other 
center of excitement. Persons having feeble digestive powers can- 
not take bulky, watery foods containing but little nutrition, as 
cabbage, turnips, etc., nor be allowed food containing much starch 
because of the unpleasant fermentation ; neither must the starches 
be given to a person who is very stout on account of their fat 
forming properties. 

THE SPARE DIET. 

The spare diet does well where there is retention of ex- 
crementitious material, and may consist of vegetables without 
meat, or with meat in very limited quantity. It is in cases of op- 
pression rather than exhaustion that the forced feeding diet pro- 
duces such disagreeable results. There are some foods, though 
not the same with every person, which must be omitted from the 
diet of the sick ; they are such articles as veal, young lamb, pork, 
duck, goose, fat and oily fish, cabbage, turnips, nuts, dried fruits, 
and fruits too richly preserved or seasoned. It is well known that 
more dyspetics suffer after eating the most digestible foods than 
after partaking of those articles which from their constitution must 
be considered not easily digestible. So each case must be studied 
for itself. The desire for certain food is a partial guide, if the ap- 
petite has not been perverted by faulty eating. 

FOR OBESITY. 

For obesity there are many diets, but they are all much alike 
and depend upon a lessening of the foods which produce fat. 
Sugar, starches and fats should be discarded altogether if possible, 



DISEASES OF THE SKIN. 591 

or used very sparingly, and fluids of all kinds must be taken only in 
small quantities; wine, beer, tea, coffee and chocolate should not 
be used at all. 

FOR AGED PEOPLE. 

For aged people the diet should not be pushed, even if there 
be loss of flesh ; but the meals would better be given more fre- 
quently, five or six times daily, light in quantity and very digestible 
in quality. 

THE POWER OF MIND OVER DISEASE. 

There is perhaps no other stimulant that so excites the tissues 
and glandular activities to their best work as the hope of recovery. 
This should be based on the fact that everything is being done, 
scientifically, to place the tissues and glands in the best possible 
condition for the performance of their functions. There is no 
lack of harmony between this and belief in our dependence upon a 
higher power, call it the Great Physician, the Divine Healer, or 
what you will. Unsustained by the Creator there is no human 
being who could live a minute. But in the plan of soul healing 
the- Lord uses instruments, even his people, to accomplish the 
work; and not only are they expected to employ earnestness, tact 
and judgment, but in every proper way to use material things 
to promote the cure of sin-sick souls. 

Why not so in bodily healing? Shall not the Christian phy- 
sician, to alleviate suffering and combat disease, use his best ability 
also, and, while asking for divine guidance and blessing, apply 
well tested remedies with the skill born of study and experience, 
rather than try to make the sufferer believe there is no such thing 
as pain, or lie down supinely and ask God as a reward of faith to do 
the whole job by miracle? Why should not the declaration of 
James that "faith without works is dead" apply as well to the sick 
as to the sinner? 



CHAPTER IV. 

DERANGEMENTS OF MENSTRUATION. 

In all acute and chronic diseases of the general system there 
may be derangements of the menstrual function. In fever and 
pneumonia, either during the acute attack or in the convalescence, 
there is apt to be scanty or missed menstruation, but in a few cases 
there may be a profuse or frequent flow, due to the relaxation, or to 
a hemorrhagic condition. This may likewise occur in the eruptive 
diseases, as scarlet fever, measles, small-pox, and sometimes in 
malarial fever. The failure to menstruate in these diseases is 
usually due to bad nutrition. 

The treatment must be directed to the management of the 
constitutional disease, and with recovery will come alleviation of 
these disagreeable symptoms. The same treatment usually an- 
swers for uterine hemorrhage, in this class of cases. 

HEMORRHAGE. 

If the hemorrhage is very severe, medicinal and mechanical 
means must be used for its direct relief. 

Such cases should be under professional care, but in case the 
bleeding is so sudden and profuse as to endanger the patient's life 
before the doctor can arrive, the entire vagina should be filled im- 
mediately with absorbent cotton. A one-fourth pound or more 
is usually required, and it must be packed in so solidly and firmly 
as to arrest the flow of blood, thus leading to the formation of 
clots in the uterus. 

Antiseptically prepared cotton is also very essential to 
the stanching of any hemorrhage and the proper dressing of 
external wounds ; it costs but a trifle; and should always be kept in 
every home, tightly sealed and never opened until an emergency 
arises requiring its use. 

The chronic conditions which impair the nutrition and thus 
cause menstrual irregularities are scrofula, tuberculosis and syph- 
ilis; then, too, there are the poisons caused by lead, tobacco, ma- 

592 



DISEASES OF WOMEN. 593 

laria and foul air. Women who are scrofulous and inclined to fat, 
and are phlegmatic in temperament, are especially likely to miss 
their periods, or to have only a scanty flow. In the last stages of 
consumption menstruation always ceases on account of the malnu- 
trition caused by the disease. This may also occur in those pre- 
disposed to scanty menstruation, even in the earlier months of 
tuberculosis. In the secondary stage of syphilis there is a marked 
loss of red blood corpuscles, and in the consequent anemia, men- 
struation is often suppressed, or of short duration. The loss of red 
blood corpuscles seems to be the cause of failure of menstruation 
in chronic poisoning. The treatment should be directed to the 
building up of the system with tonics and proper diet under the 
most favorable surroundings that the patient can secure. 

When the menstrual failure is due to imperfect digestion, lack 
of assimilation, or imperfect elimination, it is very evident that 
every measure must be taken to bring all the organs and glands 
of the body up to their best working possibility. The main 
causes are improper food, overwork and confinement indoors, or 
the opposite of this, over-indulgence in rich food, and a lack of 
wholesome and necessary mental and physical occupation. 

The missing of the menstrual period may be due to some nerv- 
ous shock, excitement, unrest, anxiety, or change of residence. 
The symptoms of the approaching menses may be present in an 
exaggerated form, as backache, headache, etc., also more or less 
derangement of the digestive organs. By beginning early, such 
cases can often be relieved by securing mental quiet and rest. 
The bromide of sodium or of potassium, in from ten to fifteen 
grain doses, is of great value unless the patient is very much de- 
pressed. At the same time stimulating food, bathing, friction of 
the skin, or artificial heat applied to the extremities, aid in the 
restoration. If mental excitement still prevails, massage, electri- 
city, frequent light meals and attention to the bowels give relief. 
At the time of the next period some diffusible stimulant should be 
given, or the aromatic spirits of ammonia in half-teaspoonful doses 
in a cup of hot water administered every two hours through the 
day. If this fails, attention to the general health during the month 
must be given, and, just before the time for the next menstruation, 
electricity should be passed through the pelvis and the special 
stimulative treatment renewed. 



38 



594 ' DISEASES OF WOMEN. 

NERVOUS EXHAUSTION. 

This is a fruitful cause of missed menses. This condition 
comes on gradually with the failing health, and no doubt is often a 
conservative provision for preventing the more sudden loss of 
strength, by preserving the blood supply. Occasionally there is in- 
creased hemorrhage, which may occur at irregular intervals, where 
there is congestion of the brain. The flow is then usually accom- 
panied with much pain. The treatment lies in the care of the gen- 
eral disease with stimulants and sedatives to aid the flow and 
diminish the pain. 

Nervous exhaustion, coming on during prolonged lactation, 
is of frequent occurrence toward the end of the first year, in case 
the menses fail to appear after the eighth to tenth month, and all 
the disagreeable symptoms of this disease may appear in full force. 
A gradual weaning of the child is the most important measure of 
treatment, and usually the prostration does not come until late, 
about the twelfth month, the time when the baby ought to be 
weaned. All other means must also be used to restore the system 
to its natural tone. 

DERANGEMENT OF SEXUAL FUNCTIONS. 

There is often a premature sexual excitement in very young 
children, even while in the cradle, probably due to chafing by the 
napkins, and later by the clothing, or to worms, or to eruptions 
about the genital organs. It is not Hard to discover this excita- 
tion, because such children do not try to conceal their unnatural 
behavior, but when a little older they are likely to be fond of being 
alone at least part of the time. If a child is irritable and fretful, 
with a capricious appetite and a headache that cannot be accounted 
for, it is well to learn if there is any handling of the genitals, or 
friction by rubbing against chairs or other furniture, with perspira- 
tion and relaxation afterward. The treatment is to remove all 
causes of irritation and to keep the child under constant super- 
vision night and day. Corporal punishment rarely does any good 
in these cases, and the old-fashioned method of spanking may 
only increase the excitation. A great deal can be done by the 
mother and teacher by drawing the child's attention from her- 
self. 

This unnatural sexual excitement, as well as excess of the 
normal function, is attended by dire results. Even when the appe- 



DISEASES OF WOMEN. 595 

tite seems fairly good, and the stomach is capable of digesting 
the food in a creditable manner, there is a failure of assimilation 
and the individual shows a lack of proper endurance, being easily 
fatigued and exhausted. There is likewise inability to do concen- 
trated brain work, and, if forced to do it, symptoms of irritability 
predominate. Sleep at first is good, but later there are wakeful 
nights, especially following overwork. The symptoms are simply 
those of mere exhaustion. Strength is regained by cessation of 
the excess, to be lost again upon return to indulgence. 

Ignorance of the result, in a majority of cases, leads to a grati- 
fication of the sexual instinct which, with cultivation of the ex- 
citement, becomes an abnormal passion. In some it is the over- 
flow of a precocious or very emotional nature ; in others there may 
be local diseases of the sexual organs. Perversion of this func- 
tion by the adult may also lead to disease of these organs. The 
treatment for the single is to stop the indulgence; for the mar- 
ried, to modify it to the limit consistent w T ith good health. Tonics 
and sedatives are indicated, and should be prescribed by the physi- 
cian. 

If the people would only understand that it is within the 
province of the physician to cure this disease, just as it is to cure 
any other functional disorder, many a wretched individual might 
be restored to the full control of himself or herself, well, strong 
and happy. The family physician should always be consulted 
freely and unreservedly, for this disease or inherited tendency will 
be as carefully guarded as any other ailment, and the public will 
never learn through him of the struggle for a better life, which is 
the privilege of all. The custom of consulting traveling quacks 
and irresponsible advertising charlatans, masquerading under the 
name of non-interested physicians, for advice and treatment 
of these serious disabilities, results in great harm, and sometimes 
in despair. These conditions are amenable to treatment, and, in 
the earlier stages, very satisfactory results are obtained and the 
normal functions restored ; even in cases in which there have been 
many years of sexual excitation and liberal indulgence, appropriate 
treatment will alleviate the distressing symptoms and restore 
strength and better health. 

A few women have a morbid sexual excitation leading them to 
be loud in their manners, sometimes hysterical, and they are ren- 
dered worse by society and lack of systematically arranged duties. 



596 DISEASES OF WOMEN. 

By proper management, under the care of a physician, they also 
can be made comfortable and of value to themselves and the com- 
munity, instead of going to ruin, and becoming a curse to the 
world. 

There are many women who may go through life, if the sexual 
instinct be not aroused by evil associates, courtship or marriage, 
without sexual desire, while others may suffer greatly through 
widowhood, or from the incomplete coitus designed to prevent 
pregnancy. There are some persons without sexual desire because 
of defective generative organs, and such should not marry ; others 
in whom it is tardily and slowly developed, if at all, and still 
others who have the appetite, but experience no gratification be- 
cause of exhaustion, mental depression or melancholy. 

When there is decided organic disease of the sexual organs, 
which would interfere with the exercise of their functions, it con- 
stitutes a barrier to marriage which must not be disregarded, 
especially if incurable. Functional diseases, as failure of menstrua- 
tion, and the like, and the non-specific inflammatory diseases do 
not stand in the way of union. 

ACUTE INFLAMMATION OF THE PELVIC ORGANS. 

Acute inflammation is the same everywhere, although its 
course may be modified by the tissues or organs involved. Acute 
inflammation of the cellular tissues, lymphatics, Fallopian tubes 
and ovaries is likely to go on to suppuration, while pelvic periton- 
itis usually ends with exudation. The first step in an inflammation 
is congestion, accompanied by a deranged nervous condition, and 
next come its exudations. In some cases the inflammation stops 
short of suppuration and the products are carried away slowly 
by the lymphatic system ; in others it goes on to suppuration, 
and sometimes to the formation of adhesions and indurations, 
binding the pelvic organs down in abnormal positions and com- 
pressing their nerves, thus giving rise to reflex indigestion and 
headaches, and from constant irritation, paving the way to nervous 
prostration with all its symptoms, as lack of strength, loss of en- 
ergy and ambition, and inability to accomplish even the most ordi- 
nary tasks of life. 

When there is pus in the pelvic cavity, a surgical operation is 
usually the only safe procedure, for, if allowed to remain, there is 
always danger, in addition to that of blood poisoning, that a rup- 



DISEASES OF WOMEN. 597 

ture may occur from some manipulation or strain and the pus 
escape into the peritoneum, giving rise to a general peritonitis fol- 
lowed with almost sure death. As long as there is no pus there is 
no immediate need of an operation, unless the woman's life is ren- 
dered unbearable by the irritable condition of the pelvic organs, 
bound down in unnatural positions and rendered incapable of the 
performance of their functions : but, if medicinal means fail, sur- 
gery may have to be employed. 

The duration, termination and consequences of a pelvic peri- 
tonitis depend upon the extent of the inflammation and its causes. 
In some cases, where the inflammation is limited, recovery will 
take place in a few weeks, with little after effect ; while in others 
the entire pelvic peritoneum becomes involved, the fimbriated ex- 
tremities of the Fallopian tubes, being included by the exudation, 
are practically destroyed, and the functions of the ovaries arrested, 
because of the structural damage. Under these circumstances de- 
generation of the ovaries often occurs ; sometimes they become 
inflamed and soft, at other times atrophied, probably due to the 
interrupted circulation within them and the contracting action 
of the exudation. In some of these cases the organs are so de- 
stroyed, or so buried in inflammatory tissue, that at a post-mortem 
it is impossible to distinguish them from it, a mass of inflammation, 
covering the uterus and broad ligaments, being about all that can 
be found. If such persons survive the attack of inflammation they 
suffer from pelvic pain, which is exaggerated at the menstrual 
period, unless the flow is arrested entirely by destruction of the 
ovaries. 

In all forms of acute pelvic inflammation, there is fever, pelvic 
pain and derangement of the functions of the pelvic organs, but 
the different cases vary as to the other symptoms, according to 
the degree of involvement; there is usually derangement of the 
digestive organs, and there may or may not be a chill. The pain 
is most marked in ovaritis and peritonitis. If the attack comes on 
at the time of menstruation there may be an increased flow. There 
is often pain in the bladder and rectum, and tenderness upon pres- 
sure in the groin. This pain is increased by movement, and there 
is not much modification of it until the exudation is complete, 
when the fever becomes lower. If pus forms there will be another 
rise of temperature, usually preceded by a chill, and this fever will 
be continuous until the abscess opens and the pus is freely 



598 DISEASES OF WOMEN. 

discharged. If at this time the fever goes very high, it indicates 
severe blood poisoning. 

There is a form of pelvic inflammation in which blood poison- 
ing develops at the outset and is very dangerous. If the seat of 
the trouble can be located in the uterus, ovaries or tubes, removal 
of the cause by a surgical operation is the proper treatment. Blood 
poisoning, indeed, is one of the chief causes of acute inflammation, 
and the other principal causes are venereal diseases and wounds. 
Certain lowered conditions of vitality undoubtedly predispose to 
acute pelvic inflammation. The treatment consists in giving relief 
and hastening the termination as much as possible. The most 
comfortable position is on the back, with the thighs flexed ; rais- 
ing the foot of the bed is often beneficial. The extremities should 
be kept warm. Warm fomentations applied to the abdomen are 
gratefully received. Counter-irritants, in the form of mustard paste, 
turpentine stupes or capsicum plasters, relieve in some cases. 
Cathartics (saline cathartics are best) are essential to eliminate the 
blood poisoning, and food that can be assimilated must be given 
to sustain the strength. 

The stomach is invariably more or less upset at these times, 
especially when the peritoneum is involved. The thirst should be 
relieved by bits of pure ice or small amounts of sterilized water 
taken cold, but if that is not retained, try sips of hot water. If 
vomiting continues, all fluids by the mouth must be stopped, an 
enema of water given to relieve the thirst and one of peptonized 
milk to supply nourishment. To relieve the stomach various 
medicines are employed, the simplest of which is hot water, warm 
tea or aerated water in small doses, with fifteen grains of bismuth 
subnitrate every two hours. No solid food should be given when 
the stomach is irritable. 

When the acute symptoms have subsided and there is no evi- 
dence of pus, the absorption of the exudate is favored by counter- 
irritants, as iodine or blisters repeated. While any products of in- 
flammation still remain in the pelvis the greatest care should be 
taken to guard the patient against exercise. Standing, walking 
or riding may produce a relapse. The patient should very care- 
fully feel her way in sitting up, and later in walking, especially 
at the menstrual periods. Any exercise that excites pain should 
be avoided. These disorders are too serious to be managed en- 
tirely by domestic treatment, and advice in each case should be 
early sought from a competent physician. 



DISEASES OF WOMEN. 599 

CHRONIC INFLAMMATION OF THE PELVIC ORGANS. 

Metritis. — Although chronic metritis may be due to septic 
or to specific diseases, there are many cases winch are simply 
catarrh of the cervix, or of the body of the uterus, or of both com- 
bined, and require medicinal treatment only. The specific and 
septic cases may also need this treatment in addition to surgical 
relief and constitutional remedies. Catarrh of the neck of the 
uterus is more common than that of the body of the uterus, but the 
former, by extending", is likely to involve the bodv also. The neck 
and body differ both in structure and function, and there is a dif- 
ference in the inflammations that occur in them. 

The ordinary course of an inflammation in a mucous mem- 
brane is congestion and excessive secretion, then suppuration or 
a purulent secretion, sometimes, though rarely, ulceration, and in 
a specific case there may be exudation of plastic lymph, then re- 
covery. The amount of damage done depends upon whether the 
inflammation ends in suppuration, ulceration or exudation. These 
are typical endings of inflammation, but in a mucous membrane 
the process may stop at congestion and excessive secretion, and 
remain there. If this be kept up there will be a change in the 
tissues, but there will not often be suppuration or ulceration. 

Cervicitis. — In inflammation of the cervix there is a very act- 
ive congestion and secretion from the glands. It is generally like 
the normal secretion but excessive in quantity. If the congestion 
continues, the cells of the mucous membrane are shed faster than 
they are replaced by new cells, so that the surface becomes covered 
only by young cells, which give it a reddish color. This process 
is not confined to the cervical canal, but extends outward about 
half the width of the cervix and is often called ulceration of the 
cervix uteri. There are other changes which appear in septic, 
specific and traumatic endometritis, but discoverable only by the 
physician. 

Endometritis is the name given to an inflammation of the 
mucous membrane lining the uterus. It may extend to only a 
part of the lining, or it ma}' spread over the entire membrane. 

As the inflammation increases, the mucous membrane in- 
creases in thickness by increase of tissue and thickness of blood 
vessels, so that it is too large for the surface which it covers, hence 
wrinkles, giving the surface a granular appearance. The conges- 
tion sometimes extends to the middle coat of the cervix, in which 



600 DISEASES OF WOMEN. 

case the tissues are softened and swollen. Accompanying this con- 
dition there is usually leucorrhea and increased menstrual flow; 
very rarely the menstrual flow is diminished. In cases where 
there is a laceration of the cervix this new tissue may become very 
firm and hard. 

Chronic inflammation of the body of the uterus is essentially 
the same as in the neck, except that in the former there is greater 
liability to the formation of polypoid growths. Cervical catarrh 
is not always attended by great constitutional disturbances, but 
when they do appear they take the form of nervous debility, the 
patient being easily fatigued, with a change in disposition and 
lessened mental activity. The leucorrheal discharge is opaque, 
thick and tenacious. If the disease is long continued backache 
comes on, the pain being in the sacral region, and there may be 
some pelvic pain. All these symptoms are aggravated by muscu- 
lar exercise and by the menstrual period. If there is also corporeal 
endometritis (inflammation of the entire mucous lining of the 
uterus) there will be, in addition to these symptoms, greater de- 
rangement of the digestive organs and of the menstrual function 
— there usually being increased menstrual flow, except in cases 
of long standing, where it may be decreased. 

The predisposing causes of endometritis are imperfections in 
the general organization and in the development and growth of 
the sexual organs, and scrofulous or tubercular tendencies. The 
exciting causes of cervical endometritis are vaginitis and injuries 
of the cervix ; the causes of the corporeal variety are imperfect re- 
covery from the menstrual period and derangements of menstrua- 
tion. When the uterus is undersize, or malformed, even in a slight 
degree, so that menstruation is imperfectly performed, inflamma- 
tion is very likely to come on sooner or later. Unsuitable cloth- 
ing, sedentary habits, over-fatigue in standing or walking, or any- 
thing which interrupts the return pelvic circulation, favors it, and 
the chronic forms are encouraged by any impoverishment of the 
blood, as from lack of food, overwork, prolonged lactation, fre- 
quent childbearing, or deranged nutrition from any cause. In 
many instances the sewing machine, the typewriter or the bicycle 
has been the offending agent by increasing pelvic congestion. 
Other exciting causes of uterine inflammation are an imperfect re- 
turn of the uterus to its normal condition after labor or menstrua- 
tion, injuries to the uterus during confinement or from displace- 



DISEASES OF WOMEN. 601 

ment, abortion, 'especially if produced, intemperate sexual indul- 
gence, and efforts to prevent conception. 

Treatment. — Attention should first be given to the general 
health. In the earlier stages there is a possibility that this general 
treatment will answer every purpose if used in conjunction with 
the vaginal douche once or twice daily. A teaspoonful of pow- 
dered borax should be added to the quart of water, which should 
be as hot as can be borne by the patient. A good douche consists 
of two or three quarts of water thus prepared, and should be 
given the patient while lying on her back with the hips elevated. 
One of the best ways is to have her lie across the bed, her hips well 
drawn over the edge of the bed, her feet resting on a chair op- 
posite, and a piece of oilcloth to conduct the return ilow of water 
into a slop-jar at the edge of the bed. A douche taken by a pa- 
tient in the sitting position over a chamber is of comparatively 
little value, except for cleansing purposes ; while that given by the 
other method and retained longer aids in the reduction of inflam- 
mation. 

Along with constitutional remedies and the removal of the 
cause belong attention to rest, diet and exercise. Those who are 
exhausted require a restorative diet, while those who are of full 
habit should have a restricted diet. There are medicines which act 
directly upon the sexual organs, but they must be used under the 
direction of the family physician, who must be the judge of the 
advisability of their use at any particular stage of the disease, the 
quantity needed, and the drugs desirable in each case. 

CONGESTION OF THE OVARIES. 

Ovarian congestion gives rise to functional troubles, which 
resemble ovarian inflammation, but differ from it in that there is 
no diseased condition found upon post-mortem, and that all the 
symptoms yield rapidly to treatment. The congestion may be of 
long or short duration. If the cause be removed it may disappear 
without treatment, but, if continued, may go on to the change 
of life, rendering the organs liable to more serious complications 
in the form of inflammation at any time. This congestion occurs 
most frequently in the unmarried and in young widows who have 
never had children, and is usually found in both ovaries, with an 
extension later to the uterus. It comes on slowly in those who 
are nervous and emotional and who live a life favoring excitation. 



602 ' DISEASES OF WOMEN. 

In the beginning there is pain and heaviness in the region of 
the ovaries, generally accompanied by nervous irritability and 
weakness,, the patient being easily excited and quickly fatigued. 
The pain in the ovaries increases from four to six days before the 
menstrual period. Later the menstrual function becomes de- 
ranged, and there is usually an increased flow, which at first relieves 
the congestion causing it ; when it does not, weakness will soon fol- 
low from lack of blood, with nerve exhaustion which may last any 
length of time. There is often backache and pelvic pain on walk- 
ing. In the earlier stages, walking sometimes gives permanent 
relief, but not always. There may be an irritability of the bladder 
which is purely nervous. Upon deep pressure in the region of the 
groin there is tenderness of a dull character, usually on both sides. 
Sometimes steady pressure in these regions gives relief. 

This condition yields very readily to the proper treatment. 
The majority of patients recover and, if the cause is removed, re- 
cover without treatment. One of the chief causes is overstimu- 
lation of the emotions in those of a nervous temperament, espe- 
cially among those not usefully employed and permitted to turn 
their attention to the procreative function, even before develop- 
ment is complete. Stimulating tonics and improper or evil social 
influences favor ovarian congestion. It may also be secondary 
to endometritis, sedentary habits or constipation. 

Treatment consists in removal of the cause. Often the end- 
ing of an engagement in marriage has been sufficient for com- 
plete relief. In young patients good results are obtained by direct- 
ing the attention to things outside of themselves — a change from 
society to books, the woods and fields and outdoor amusements. 
Bathing is good, either the sea or shower bath. Tonics to re- 
store the tone, with sedatives, are needed. 

CHRONIC OVARITIS. 

The ovary is different from other organs of the body, since 
its function is performed at the expense of a portion of its struc- 
ture, which is never restored to its former condition. The rupture 
in ovulation of each Graffian vesicle means the destruction of that 
vesicle. Rudimentary vesicles mature and repeat the function, and 
are in turn destroyed. At least the supply ceases before the or- 
ganization as a whole has reached the end of its activities. In all 
other organs of the body functional activity is the result of cell 



DISEASES OF WOMEN. 603 

destruction and restoration. The chronic inflammation of the 
ovaries is more like a chronic inflammation of the kidneys, the 
pathological conditions being entirely different from those of acute 
ovaritis, arising from puerperal or specific causes; as following 
acute peritonitis. 

The first step from normal is irritability and nervous disturb- 
ances, which are the more frequent from the close connection 
of the ovaries with other organs. These symptoms are usually 
temporary, but, if often repeated and prolonged, produce changes 
in the circulation which finally impair nutrition. This congestion 
can be relieved by proper treatment, but, if allowed to continue, 
there will be an increase of connective tissue at the expense of the 
true ovarian structure, which after a time will be crowded out, 
and the ovary made useless for procreation. The first changes in 
the circulation give rise to a swelling of the ovary which makes it 
larger and softer than usual. Hemorrhage into the ovary some- 
times occurs and clots may be found upon the surface. The 
ovary that is large, tender and soft will, later, become much dimin- 
ished in size, and though the changes going, on may seem like 
an increasing number of vesicles approaching maturity, they mean 
a loss of the proper substance of the ovary. 

Symptoms are both constitutional and local. The former are 
depression of the digestive and nervous systems, and the reflex di- 
gestive symptoms are a capricious appetite, nausea and some gas- 
tralgia. The bowels are frequently constipated and filled with gas. 
The nervous debility is attended with oreat emotional disturbances 
— more characteristic of chronic ovaritis than of any other chronic 
disease of the sexual organs. There is usually an increased men- 
strual flow, but, after the inflammation has lasted a long time, there 
may be a diminished flow. The ovarian pain due to ovulation 
is increased a lew days before the flow, and is usually at least 
partially relieved after the flow has lasted two or three days. 
The menstrual flow is more severe if there is also uterine inflam- 
mation. The pain likewise depends upon the structure involved; 
if it is the ovarian structure only, the pain is not as severe as 
when the peritoneum covering the ovary is also implicated. 

All these symptoms are exaggerated by standing, walking, 
riding or sitting in a stooped position for any length of time. 
Sexual excitation and coitus cause great suffering. The patient 
is usually most comfortable lying down. Upon examination the 



604 DISEASES OF WOMEN. 

ovary is tender to touch. The symptoms coincide with those of 
ovarian congestion to such a degree that we are forced to believe 
that the congestion is the beginning of the inflammation. The 
pain in ovarian neuralgia is also similar, but in that affection there 
is no inflammation and the pain is not continuous. If the patient 
is placed under treatment early, there is a chance for recovery, 
especially if but one ovary is affected. The disease in one ovary 
may go on to complete destruction and the pain then subside, ex- 
cepting occasional attacks of neuralgia, while the other ovary may 
remain well and keep up its function. If the ovarian inflammation 
is accompanied by disease of the other organs, and there is much 
destruction of normal tissue, it may be necessary to remove the 
ovaries. This operation is very rarely fatal, and, in the properly 
selected cases, gives great relief. 

One cause of this condition is poorly developed ovaries which 
predispose to disease, and another is imperfect menstruation. 
When the uterus is undersize, or turned backward or forward, and 
the menstrual flow is small and attended with pain, the ovaries are 
likely to take on chronic inflammation. The eruptive fevers and 
gonorrhea are factors in some instances. The scrofulous tendency 
and inherited syphilis are other factors in its causation. 

Treatment consists in lessening the blood supply and reliev- 
ing the pain. This means rest in bed in the earlier stages, with 
general exercise in the form of massage, or gymnastic movements 
in the reclining position. This exercise is as necessary for the 
general health as is the postural position to relieve the local 
condition. The poor appetite, coated tongue and constipation, or 
flatulence and diarrhea, can be removed by small doses of calomel, 
one-fourth of a grain every half hour until four doses have been 
taken, repeated daily, and followed in two hours after the last 
dose each day with a Seidlitz powder. The elimination by the kid- 
neys is improved by keeping the bowels well open. This espe- 
cially applies to cases suffering from non-elimination of effete 
products. The home treatment of these cases consists of the hot 
sitz-bath, counter-irritation and the vaginal douche given as 
previously described. General baths are of service, but should be 
given under the direction of a physician. Only a thorough study 
of medicine will give judgment as to when certain medicines 
should be given or withheld in these cases, even though the rem- 
edies and the proper average dose are well known. There is a 



DISEASES OF IV OMEN. 605 

long line of medicaments which must be left to the physician in 
order to secure the best results. It is very important to exercise 
patience and carefully watch the patient. When improvement 
comes, too many, forgetting that recovery from this disease is 
slow, become lax in their care, and thus open the way to relapse. 

INFLAMMATION OF THE FALLOPIAN TUBES. 

This disease is nearly always secondary to inflammation of the 
body of the uterus. There is first a congestion of all the structures 
of the tube, then a secretion from the mucous membrane of a 
thick, milky fluid, not containing pus. If the inflammation be 
very severe there will also be involvement of the peritoneum cov- 
ering it. As a rule both ends of the tube are closed by inflamma- 
tory adhesions. Sometimes there are no traces of the inflammation 
left, except closure of the tubes, but at other times fluid collects 
in the tubes and their walls become very thin. This is known 
as tubal dropsy. The inflammatory obstruction of the uterine 
end of the tube may give way and the fluid be discharged. This 
may end the trouble, or the fluid may again collect and discharge 
for several times, and recovery then take place, but this happy 
termination is an accident not to be expected with assurance, 
for rupture of the thin walls is apt to occur and to be followed by 
less favorable results. 

Symptoms. — This trouble so follows chronic endometritis 
that its symptoms are not distinct from those of the latter disease 
unless there is a complicating peritonitis. There is usually pain- 
in the affected tube, which comes and goes, and is more decided at 
the menstrual period. Standing or walking increases the pain ; 
the nervous and nutritive systems are more or less disturbed, and 
there is no fever unless complicated with peritonitis. The tube 
is tender to touch and can be felt as a hard, thick mass, or series 
of masses, characteristic of the disease. 

The treatment must be applied to the removal of the cause of 
the primary disease, which almost invariably is endometritis. Sur- 
gical means may be required if other procedure fails, or there is 
danger of rupture of the tube into the peritonum, with the prob- 
ability of peritonitis following. 



CHAPTER V. 

DISPLACEMENT OF THE UTERUS. 

Many cases of displacement can be managed early by rest with 
the aid of the postural treatment and proper general medication. 
In order, however, to be successful the treatment must be begun 
upon the slightest indication of trouble. The uterus is entirely 
within the true pelvis. In the diagram (Fig. i, Plate VIII), the 
true pelvis is bounded by the line A B, and the long diameter of the 
uterus corresponds very nearly to the axis of the pelvis, which is 
represented by the line C D, and is equally distant from all other 
parts of the pelvis. As regards its relation to other organs within 
the pelvic structure, the uterus is in the center, a Fallopian tube 
and ovary being on either side, the bladder in front, the rectum 
behind, and the vagina below. The broad ligaments are the part 
of the peritoneum covering all these organs, excepting the vagina, 
and are attached to the bony sides of the pelvis. The round liga- 
ments, containing muscular tissue, are usually outgrowths of the 
muscular tissue of the uterus, and, in the form of round cords, 
start from the uterus near the beginning of the Fallopian tubes, 
sweep around the sides of the pelvis and attach in front. The 
utero-vesical ligaments also extend from the uterus to the front 
walls of the pelvis and are indirectly connected with the front 
vaginal wall through the connective tissue. The utero T sacral liga- 
ments are likewise attached to the back vaginal wall and to the 
rectum in the back portion of the bony pelvic canal. 

The chief use of these ligaments is to keep the uterus and 
bladder in position and, with the vagina and other pelvic organs, 
is sufficient under ordinary circumstances; but, when a great 
strain is brought upon them, the pelvic floor aids these structures. 
The relation of the trunk to the pelvis helps in keeping the pelvic 
organs in place, being so arranged that the line of equilibrium falls 
in front of the pelvic cavity upon the front bone of the pelvis. This 
is why it is so important that women stand and walk perfectly 
erect. By bending they bring this line within the pelvic cavity 

606 




J/ormid. 




Retroflexion 



FIG. 1 



FIG. 2. 




J rite version. 



J til e fie * i on. 



FIG. 3 



FIG. 4. 



PLATE VIM. 



DISEASES OF WOMEN. COT 

and thus place the pressure of the abdominal contents fully upon 
the pelvic organs. The pelvic floor aids indirectly in supporting 
the uterus, which is a movable organ, being pushed backward by 
the distention of the bladder and allowed to fall forward when the 
bladder is empty. The full rectum also pushes the uterus for- 
ward, and the abdominal contents by their continual changing 
constantly affect the position of the pelvic organs from above. 
These changes of position are natural, while limited, and tempo- 
rary, but when the uterus is greatly displaced and permanently 
remains so, there result disordered functions of the bladder, rectum 
and general system, deranged menstruation and circulation, and in 
some cases sterility. In young girls the main cause of all displace- 
ments is lack of development during infancy and childhood, often 
due to defective nutrition and improper positions in sitting or 
standing, or to some strain ; as from lifting heavy furniture, at- 
tempting difficult or impossible feats in calisthenics, etc. In mar- 
ried women, the great cause is pregnancy and its attendant 
changes, and lack of care immediately following delivery. 

The chief displacements are anteversion, anteflexion, pro- 
lapsus, retroversion and retroflexion. Typical examples of these 
conditions are shown by the diagrams of Plate VIII. , which rep- 
resent the uterus with its ligaments removed. To study the 
ligaments and their relation to the uterus, see page 498. 

Anteversion is the tipping forward of the top of the uterus, 
its neck lying in the back of the pelvis without making any bend 
in the uterine canal. 

Anteflexion is a tipping forward of the uterus, the neck also 
looking forward, but bending upon the body, thus creating a bend 
in the uterine canal, which interferes with menstruation and proper 
circulation, and gives rise to passive congestion, followed by in- 
flammation. 

Retroversion is that form of displacement in which the uterus 
and neck both bend backward and rest low upon the rectum. The 
uterus may be temporarily retroverted by pressure from a full 
bladder, and not give much cause for unpleasant symptoms, but, 
if it becomes permanent, irritation usually results. 

Retroflexion is a tipping backward of the uterus, while the 
neck points forward ; it is usually the first stage of prolapsus. 

Prolapsus is simply a descent of the uterus, often called ''fall- 
ing of the womb." A prolapsus in which the uterus remains 



608 DISEASES OF WOMEN. 

within the vulvae, is called incomplete ; where it extends partially 
or wholly beyond the vulvae, it is called complete. There is al- 
ways some prolapsus with retroversion, and vice versa some ret- 
roversion with every prolapsus. Displacements, as a rule, are 
brought about slowly — months or years intervening before they 
come under the physician's care. The changes which take place 
in the uterine supports are the same in all cases, but they vary as 
regards the cause and the beginning disease. There are three 
methods of development of prolapsus: (i) The uterus leaves its 
place because it is too heavy, or the supports are weakened by 
disease. (2) By a loss of the pelvic floor the vagina, bladder and 
part of the rectum are allowed to descend and the uterus follows. 
(3) A class of cases made up of those in which the causes of the 
first two methods act in conjunction. 

The changes in the supports are a lengthening of the liga- 
ments of the uterus after confinement ; the condition may also be 
caused by a heavy uterus, or by continued pressure from above 
from long standing, stooping or lifting. The resulting pressure 
upon the blood vessels is thought to interrupt the return circula- 
tion. All of these changes are developed very gradually. 

Prolapsus of long standing changes the structure of all the 
tissues. There is a degeneration of the muscular tissues of the 
vagina, and the ligaments of the uterus lose their characteristics 
until they cannot be restored. This occurs most fully in old and 
very feeble women. Where there is a loss of the pelvic floor, a 
surgical operation is necessary to effect repair. If the ligaments 
are permanently relaxed, some form of support must be adjusted 
or the uterus must be removed entirely. 

Symptoms. — The symptoms of these displacements are pain 
in the bladder and rectum, due to pressure upon them by the 
uterus. There is often a constant desire to empty the bladder and 
rectum, which is increased by walking, lifting or coughing, and 
especially by long standing, but is completely relieved by assum- 
ing the recumbent position — the position which gives relief in 
other diseases of the pelvic organs also, but not such complete re- 
lief as it affords in prolapsus. The irritation and deranged cir- 
culation lead to inflammation of the uterus and other organs, not 
to an acute, but to a chronic condition of congestion and inflam- 
mation of the mucous membrane. It is probable that the endome- 
tritis so common in displacement precedes it, but the inflammation 



DISEASES OF WOMEN. 609 

is kept up by the displacement. Menstruation may be deranged, 
there often being too great a flow, and, in retroversion, the dis- 
charge may be offensive. Backache, deranged digestion and de- 
pression are also general symptoms. 

In considering the cause of uterine displacement, we should 
bear in mind that the nice adjustment of the uterus which per- 
mits the great changes it undergoes in pregnancy renders it ex- 
ceedingly liable to loss of equilibrium. The shape of the pelvis, if 
large and shallow, favors the falling of the uterus, although it pro- 
motes easy labor; and if the pelvis is tipped forward, there is 
greater pressure upon the pelvic organs from above — a condition 
unfavorable to uterine stability. 

The tissues of the uterine supports are often imperfect, in 
which cases they are incapable of doing their work. These im- 
perfections may arise from failure of development, or may occur 
from sedentary habits in youth, or from the debility of disease. 
Standing or walking until fatigued brings undue strain and, if 
kept up, will in time cause falling of the uterus, and a sudden jar, 
as an imprudent spring from a swing or carriage, may cause it. 
Active exercise, with plenty of rest between, will strengthen the 
ligaments, while fatigue will overcome the power of resistance. 
As already intimated, the habit of walking erect maintains the 
proper relation between the abdominal and pelvic organs, but 
stooping disturbs and may lead to their derangement, for it not 
only brings increased downward pressure, but interrupts the re- 
turn circulation. The sewing machine, the typewriter, and bend- 
ing over in the easy chair, are alike harmful, but not as much so 
as the bending over her desk by the schoolgirl while her body is 
developing. Heavy lifting, if continued, and abuse of corsets, are 
factors. General weakness from prolonged sickness, or from ex- 
treme old age, is another cause, but one of the most frequent 
causes is childbearing with imperfect return of the uterus and 
ligaments to their natural condition, due to laceration, improper 
care after confinement, and the persistency with which women 
assume the ordinary duties of the household before recovery can 
possibly be complete. Enlargement of the uterus from tumors or 
from inflammation, will also cause prolapsus. 

Treatment. — Local applications and quiet rest will reduce the 
enlargement of the uterus and its ligaments, when, in recent cases, 
the organ will return to its position. Later, surgical means may 

39 



610 DISEASES OF WOMEN. 

have to be employed. First, correct any defects in the clothing 
and habits of life that may have caused the displacement. Loose, 
light clothing should be worn, and sitting, standing, walking or 
lifting heavy weights should be avoided. Next, restore the uterus 
to its place by the knee-chest position, assumed three or four times 
daily for five or ten minutes, and the patient should then rest upon 
her side with the pelvis raised. Proper external support with a 
bandage is also beneficial. This treatment is certain only in early 
cases and when persistent care can be secured. Later, all the at- 
tention that the physician can give by local and surgical means 
must be used to secure any permanent effect. 

Displacements of the uterus give rise to the digestive and 
nervous symptoms found in the inflammatory diseases of this or- 
gan, and managed by restoration of the parts, proper diet and 
proper medication directed to the stomach. In the majority of 
these cases the vaginal douche is of great benefit, and should be 
medicated according to the nature of the case. The simplest 
medication for a douche is a teaspoonful of powdered borax to a 
quart of water, as hot as can be borne by the patient. The con- 
stitutional derangements accompanying the inflammatory diseases 
of the pelvic organs are principally disturbances of the digestive 
and nervous systems — the degree of disturbance depending upon 
the temperament 'and general health of the patient. Robust, 
phlegmatic women may have an endometritis, especially of the 
cervix, for years, without the manifestation of any reflex symp- 
toms, while the very sensitive patient suffers greatly. The im- 
paired nutrition tends also to aggravate the local trouble and pre- 
vent recovery. 

The appetite may be lacking for a time, then be abnormally 
active; this is most noticeable with inflammation of the body of 
the uterus, when there may be nausea as well. In some cases there 
is a coated tongue, constipated bowels, and poor appetite all the 
time, with labored digestion indicated by a fullness, flatulence, dis- 
tress and even pain after eating, and by a yellow tint to the eyes 
and skin, showing a sluggish condition of the liver. In nervous 
stomach troubles attended with dyspepsia there is often an over- 
secretion, or increased secretion, because of the increased move- 
ments of the muscular walls of the stomach. In the former condi- 
tion there will often be a sense of burning in the stomach, while 
in the latter acid eructations are frequent. Food is carried out 



DISEASES OF WOMEN. 611 

of the stomach before it is digested, hence, there are intestinal gas 
and disturbances of the bowels, with alternating constipation and 
diarrhea. The principal treatment of nervous dyspepsia in these 
cases is to remove the uterine cause. While local and surgical 
means are employed, relief for the stomach can be obtained by the 
use of twenty grains of subnitrate of bismuth, given half an hour 
before meals; when the digestion is labored, pepsin and charcoal 
taken an hour after meals will give relief. There are a variety of 
tonics and sedatives that may be used, but should be selected to 
suit the case at hand, and this must be done by the physician. 

The nervous disturbances differ according to the stage of the 
disease. At first there may be only occasional headaches, or un- 
comfortable or disagreeable feelings in the head, then a sense of 
weight on top, and after a long time there may be found a diffi- 
culty in collecting the thoughts, irritability, restlessness, disposi- 
tion to become depressed, sleeplessness, or difficulty in getting to 
sleep, then waking after a short nap. A sufficient dose of potas- 
sium bromide, ten to twenty grains, in the afternoon and again 
at bed-time, will often give the required rest until the local condi- 
tions are remedied. Baths are very beneficial, but they should be 
of warm or tepid water, then gradually cooled to get a tonic effect. 

Rest by lying down is very important in the relief of all in- 
flammatory diseases of the pelvis. It is best to have short intervals 
of exercise in cases in which it is permissible, followed by long 
periods of rest in the recumbent position, and long rest and sleep 
at night with the pelvis elevated. In the more acute forms of 
inflammation continuous rest in bed is often necessary, the exercise 
then being kept up by massage. Electricity is an aid in certain 
cases. 

Nearly all medicines which aid in restoring the uterus to its 
normal function are those which build up the general nutrition, 
and when the nutrition is fair better results are often obtained by 
a rather meager diet for a season — discarding meats and rich 
food. This applies to cases where there is a failure of elimination 
of the waste products. 

DISEASES OF THE EXTERNAL GENITALS. 

Little children may have inflammation of the vulva in con- 
sequence of the eruptive diseases, as measles, scarlet fever, etc., also 
as a result of scrofula. In adults it is more likely to be septic and 



612 DISEASES OF WOMEN. 

specific, but many of the mild forms are a result of uncleanliness. 
In little children the genitals may be neglected, or bathed in such 
a rough and careless way that more injury than good is done. It 
is best to use powdered borax — a teaspoonful to the quart of warm 
water, or soap and water, allowing a gentle stream to flow from a 
fountain syringe, but being careful not to allow the stream to 
strike directly against the vulva, then carefully clean and dry all the 
folds with absorbent cotton and throw it away each time. Towels 
are too rough for this purpose, and sponges are liable to retain 
infected matter, unless cleansed more carefully than is done in 
the ordinary household. This attention should be given by the 
mother or nurse until the child is old enough to do it for herself, 
which is usually about the time when the menstrual flow begins. 
The prepuce should receive attention since it is often adherent in 
girls, as in boys, and may give rise to much irritation and annoy- 
ance, and lead to evil results. The physician should see that 
all these defects are overcome. In middle. life the same care must 
be exercised, especially after menstruation and when there is a 
free secretion by the glands of the vulva, which may be irritating 
and offensive ; frequent bathing is necessary. Thorough bathing 
and the vaginal douche before and after exposure will also greatly 
lessen the danger of infection from diseased husbands. 

VULVITIS. 

Inflammation of the vulva is usually caused by some other pre- 
existing disease, except in children, and the specific forms. A scro- 
fulous predisposition, and certain skin diseases, may give rise to 
an inflammation in this locality, and the small pinworms of chil- 
dren are another source of irritation. If uncomplicated this in- 
flammation may be simply a flush of the skin, or an erythema, 
which usually does not last long and often passes away without 
treatment. The purulent form is more defined. The parts are then 
covered with a thick deposit of pus, and the surface of the mucous 
membrane, and the skin, if also involved, is raw and red. There 
may be small spots of ulceration and considerable itching. As the 
symptoms, heat, tenderness, discharge and itching, are similar to 
those of vaginitis and are not distinctive, an ocular examination 
is required to ascertain the exact location of the disease. 

Treatment. — The chief thing in the treatment is to secure ex- 
treme, cleanliness and to keep the inflamed surfaces separated. 



DISEASES OF WOMEN. 613 

There must be frequent washings of the vulva with solutions of 
borax, or of boracic acid, and, after thoroughly drying the parts, an 
application made of the powder subnitratt of bismuth, or oxide of 
zinc, and a very thin layer of absorbent cotton placed between the 
surfaces. In many cases the following solution answers instead of 
the powder: 

Sulphate of zinc four grains 

Fluid extract hydrastis Canadensis one ounce 

Water three ounces 

Apply three or four times daily. 

Vulvitis is difficult to manage in children and unmarried 
women, and unless the treatment is faithfully applied, results may 
be hard to obtain. For children, after the bathing heretofore pre- 
scribed, sulphate of zinc, one to three grains to the ounce of water, 
is best applied with an atomizer three or four times daily. When 
the inflammation extends up into the vagina, the vaginal douche 
must be used, and for children the soft rubber catheter should be 
attached to the fountain syringe and a thorough douche of boiled 
water given. This may be followed by a mild solution of the sul- 
phate of zinc, one grain lo the ounce. The patient ought to be 
kept in bed and under the constant care of a competent nurse. 

If this inflammation appears during an attack of scarlet fever, 
measles or diphtheria, it may show itself only in the form of a 
mild rash which will disappear without treatment, or it may be- 
come permanent, suppurative and persistent. In cases due to in- 
flammation of the rectum, worms, or specific and malignant causes, 
the primary treatment is the removal of the cause. 

PRURITIS OR ITCHING OF THE VULVA. 

This is only a symptom, but may occur when it is almost im- 
possible to discover the cause, hence has been given a place as a 
distinct affection. The patient first notices an itching of the parts 
which is relieved by scratching and rubbing, but, after affording 
temporary relief, these measures only aggravate the trouble. Often 
the tickling, sharp, burning sensation becomes intolerable, and 
obliges the patient to remain at home, and even lose sleep, unless 
hypnotics are used. For the cause of pruritis we must look to the 
cause of the disease which precedes it and gives rise to this symp- 
tom. The list of such disorders is quite a long one. 



614 .- DISEASES OF WOMEN. 

Diabetes, or sugar in the urine, is one of the principal causes 
of pruritis of the vulva, and any discharge of an irritating nature 
from the vagina or urethra may likewise cause it; thus the dis- 
charges from inflammation of the vagina, from inflammation of 
the mucous membrane of the uterus, from cancer of the uterus, 
and from inflammation of the urethra, are usually very irritating 
and, therefore, especially causative of this disorder. Rectal dis- 
eases, and certain conditions or affections of the nerves, presum- 
ably give rise to some cases of pruritis; and it is possible that a 
microbe, attending the debility from local disease and nerve de- 
pression, may yet be discovered and proven a cause. 

Treatment. — As already intimated, the treatment must first be 
directed to the cure of the disease giving rise to the pruritis, then 
measures taken to protect the vulva from the discharges which 
keep up the irritation. Vaginal discharges can usually be stopped, 
excepting those from cancer, and from these relief can be ob- 
tained by vaginal douches of carbolic acid solution, and afterward 
placing medicated cotton in the lower part of the vagina to catch 
the discharges. For the diabetic itching, separate the lips of the 
vulva while urinating, to prevent contact with the urine, then dry 
the meatus with cotton. The parts may be further protected by 
thoroughly applying an ointment of fifteen grains of boric acid 
powder mixed with a half ounce of vaseline. This treatment must 
be thoroughly and persistently kept up if a good result is expected. 
The hardest cases to treat are those in which the symptoms cannot 
be ascribed to any special disease of these parts. In these cases 
the skin is often bleached in spots, and is hard and inelastic, and, 
although they can always be relieved, some such cases are incur- 
able. Bathing with hot water and borax usually does well, and 
thirty grains of chloral hydrate and twenty grains of camphor with 
two ounces of rose water ointment is very good where it does not 
cause smarting. There are many other remedies, but they give 
best results when used under the careful management of the 

physician. 

HYPERESTHESIA. 

Hyperesthesia, or an irritableness of the vulva, occurs usually 
in young married, or sterile women, or after the menopause. 
There is great sensitiveness of the parts to touch, and pain in 
coition. While it may arise from a general nervous condition, it 
probably more frequently conies from incomplete coitus. At the 
menopause it seems to be due to a malnutrition of the parts. 



DISEASES OF WOMEN. 615 

Treatment. — The treatment consists in temporarily reliev- 
ing the condition until pregnancy takes place, when it will be bet- 
ter and, after labor, will generally disappear. Boroglyceride, and 
tannic acid and glycerin, applied to the parts, are good. When 
there is free secretion from the vulvovaginal glands, a wash of one 
part of bichloride of mercury to two thousand parts of water an- 
swers well. Constitutional remedies should be given for the de- 
bility, and sometimes a surgical operation is necessary. 

VAGINITIS. 

This is an inflammation of the vagina, caused by the extension 
of inflammation from the vulva, or from the uterus, or due to an 
infectious fever, or to a specific venereal disease. The lining of 
the vagina is more like the skin than like the mucous membrane, 
hence its inflammation resembles an inflammation of the skin 
rather than that of a mucous membrane. In the acute cases the 
symptoms are a sense of internal heat and fullness, and, later, pain 
in the vagina and uterus. In severe cases there will also often be 
pain in the bladder and rectum. There is slight fever and loss of 
appetite with a profuse discharge. 

Treatment. — Use medicated douches, as for inflammation of 
the vulva, and treat any disease which may give rise to it, or with 
which it is complicated. The remedies recommended are simply 
for home treatment ; stronger medicines must be applied only by 
the physician. 

UTERINE FIBROIDS OR TUMORS OF THE UTERUS. 

These give rise to symptoms of disease through pressure upon 
adjacent organs, and severe hemorrhages. They were formerly 
treated entirely by medicine, but now almost as exclusively by sur- 
gery, which is the only means of a perfect cure. Relief, however, 
can be obtained by medicines and electricity, and often a patient 
may be tided over the menopause when, with the decreased sup- 
ply of blood to the pelvic organs, the tumor gradually decreases in 
size, but if there is excessive hemorrhage, she must be kept quiet 
and off her feet. The medicinal treatment for hemorrhage must 
be pushed and should be under the physician's care. For a vaginal 
injection when there is much flow of blood, two quarts of hot wa- 
ter with an ounce of vinegar will often be helpful. Well fitting 
abdominal supporters may give great relief. 



616 ., DISEASES OF WOMEN. 

CANCER. 

Cancers of the pelvic organs appear most frequently near the 
menopause, or after it, at a time when the eliminating power of the 
body is beginning to fail. The direct treatment is surgical, whether 
by the knife or caustics. The former is to be preferred as less pain- 
ful and more sure. All articles of diet which prevent elimination 
should be avoided, as tea, coffee and alcoholic stimulants, and par- 
ticular attention should be given to the complete elimination of all 
waste products of the body, as a preventive treatment at this time 
of life. The food taken must be easily and properly digested ; the 
kidneys must do their whole duty; and the liver and intestinal 
tract must be carefully looked after. Turkish baths are often of 
great value in these cases. There should be taken a proper amount 
of exercise. Undue elimination and over-exercise create debility 
again, and frustrate the very object sought. The medicines are 
to be directed to the building up of the general health, the relief 
of pain, and the removal of disagreeable odors. 



CHAPTER VI. 

DISEASES OF THE URINARY ORGANS. 

The urine is slowly secreted by the kidneys and collected 
in the bladder drop by drop, the latter acting as a reservoir which 
at stated intervals expels its contents. A healthy woman urinates 
from four to six times in the twenty-four hours, and passes from 
thirty-five to sixty ounces daily, varying with the season, more 
being passed in the winter than in summer, and with the amount 
of fluids imbibed. Neither concentrated nor limpid urine is well 
borne by the bladder, and, unless emptied at the proper time, 
this organ is injured by distention, and bad results may follow if 
the retention continue. AYomen are very foolishly negligent of 
the urinary organs, and, as a consequence, not only the bladder, 
but the kidneys also in time become disordered, first by congestion 
then by catarrh. Sudden changes from heat to cold also give 
rise to trouble by quickly changing the character of the urine and 
thus causing an irritableness of the bladder. Under these condi- 
tions all stimulating drinks and foods should be avoided, and, in 
youth and old age, particular attention must be given to cleanli- 
ness of the genitals to prevent extension of disease to the urethra 
and bladder. 

Functional Diseases of the Bladder are due : First — To imper- 
fect tone of the nerves controlling it and the urethra ; as in case 
of the irritable bladder in which there is frequent urination, and 
sometimes incontinence. Second — To diseases and derangements 
of the general nervous system, as in hysteria, and diseases of the 
brain and spinal cord. Third — To diseases of the nutritive system ; 
as in cases attendant upon, or following malaria, the eruptive 
fevers, ana constitutional diseases. Fourth — To diseases of the 
ether pelvic organs; as ovaritis, metritis, pelvic peritonitis, and 
displacement of the uterus. 

The treatment must be directed to the relief of the original 
cause, upon the accomplishment of which the bladder symptoms 
will disappear of themselves. The various manifestations of 

617 



618 DISEASES OF WOMEN. 

functional diseases of the bladder are frequent urination, difficult 
urination and retention, painful urination, pain after urination, and 
inability to retain urine. These symptoms also occur in organic dis- 
eases of the bladder. 

Neuralgia of the Bladder or of the neck of the bladder, can 
generally be traced to anemia, malaria or nerve exhaustion, and 
must be reached by general treatment for these diseases. 

Incontinence or lack of power to retain the urine is usually 
a childhood disease, but may often become persistent and last into 
later years. It is due to defect in the sphincter muscle, which 
keeps the urine in the bladder until in response to an act of the 
will this muscle is relaxed and the urine voided. It may also be 
caused by excessive irritability of the bladder which overcomes the 
sphincter ; and the two causes are sometimes combined, producing 
a still more obstinate case. The habit of unconsciously voiding 
the urine at night is not only distressing and annoying, but pre- 
disposes to bad habits and often causes the individual to catch 
cold. It is sometimes caused by a defective nervous system, but 
is undoubtedly more often due to lack of training in infancy. 
Often, the exciting causes are worms, irritation of the bladder from 
an eruptive fever, a cold, piles, and irritating urine from excess of 
uric acid. Some cases are easily cured, while others resist all 
forms of treatment. As a preventive, the heartiest meal should be 
taken in the middle of the day, but little fluid allowed toward 
evening, and the food must be plain and unstimulating. The bow- 
els must be kept regular, no coffee or tea permitted, and the pa- 
tient put to bed only after the bladder has been thoroughly emp- 
tied. The mattress should be hard and the covering slight; the 
sleeping room must be well ventilated, and the genitals should 
be kept clean and dry; no places of amusement should be visited 
after dark, and the patient should be awakened to urinate when 
the family retire. If the bed is found wet the patient should be 
awakened and reasoned with if able to understand. If due to im- 
proper handling of the genitals, every means must be used to stop 
that bad habit. In women, partial inability to retain the urine is 
usually due to some injury or displacement, for which the physician 
must carefully adjust the proper treatment to each patient — medi- 
cinal, and, perhaps, surgical as well. 

In some cases incontinence has been found clue to lack of 
bladder capacity, and permanently cured by distending the blad- 



DISEASES OF WOMEN. 619 

der every other day for six weeks by injecting a four per cent so- 
lution of boric acid to the point of discomfort, with a fountain 
syringe, but this must be done only under the directions of the. 
physician, who will use all the antiseptic precautions. 

Due to a fault in the general nervous system, many women 
are annoyed by frequent urination whenever excited in any way. 
They are sensitive and sympathetic, and joy, fear or sorrow causes 
it, the oftener they urinate the oftener the necessity occurs. If 
the will power is strongly exerted to resist the inclination, recov- 
ery will usually follow. 

Paralysis of the Bladder. 

The principal functional derangements of the bladder due to 
nutritive and nervous diseases are incontinence and paralysis; but 
hysteria also is often a cause of retention, as well as of incontinence 
of urine. Disease of the spinal cord may be a cause, giving rise 
to permanent paralysis; and there ma}' be a temporary paralysis 
caused by dysentery, diphtheria or disease of the bladder walls. 
In the latter case in elderly people, the prospect of recovery is fa- 
vorable only under prolonged treatment. In cases where there is 
fear of distention, the bladder should be emptied artificially at 
stated intervals, and it is of the greatest importance that the 
catheter be surgically clean. If it be boiled for thirty minutes in 
soda water, there will be no clanger. 

Various Abnormal Conditions. 

Abnormal urine constitutes one of the many factors of blad- 
der derangement. Normal urine is of a certain character, and any 
change in it is quickly felt — if too acid, too alkaline, too limpid, or 
too greatly concentrated, the bladder inclines to expel it. 

Deposits of urinary salts in the walls of the bladder may 
irritate and tend to a chronic condition. Beginning with these 
small deposits, their rough surfaces favor additional deposits, 
until stones are formed, but this usually occurs only where there 
is decomposing urine in the bladder. AYhen there is a deposit of 
uric acid, there is either an excess of the salts in the urine, or a 
condition of the secretion which permits deposit when the uric 
acid is present in normal, or even less than normal quantity. It is 
often necessary to make several examinations of the urine in twen- 
ty-four hours to discover an abnormal specific gravity, for often 



620 - DISEASES OF WOMEN. 

at other times it may be in excess, and give rise to considerable 
irritability. A bladder that is irritable at all times, even when the 
urine is found to be normal, is likely to be so because of nervous 
disorders, and must be treated along that line. 

The symptoms arising from abnormal conditions of the urine 
are frequent urination and pain after urination, and when these 
abnormal conditions are allowed to persist for a long time there 
is danger of a chronic inflammation of the bladder. In cases of 
concentrated urine, due to fever, the treatment consists in drink- 
ing a liberal amount of water, usually of some of the alkaline wa- 
ters if the urine is too acid. In digestive troubles, where there is 
much acid or a saline deposit, attention must be given to diet, 
bathing and regulation of the bowels, and to taking a proper 
amount of exercise. Where these deposits in the urine are found 
there is usually some defect in the assimilation which must be 
corrected.. Limpid urine is usually due to brain disease, or some 
nervous trouble, and the treatment must be directed to this cause. 
Malaria is another cause of derangement of the bladder, and is 
most easily discovered by noting its periodicity. The treatment, of 
course, is for the malaria, the relief of which is promptly followed 
by relief of the bladder trouble. 

Functional disease of the bladder, due to disease of the ad- 
jacent organs, often occurs. The symptoms are not unlike those 
due to organic trouble, except that they are cured by relieving 
the causative disease. Disorders of the rectum may cause pain 
in the bladder, and chronic hemorrhoids often cause frequent 
urination. A great many cases of spasms of the vagina are com- 
plicated by an irritable bladder. Acute peritonitis and cellulitis 
cause great pain in the bladder, giving rise to the desire to urinate 
without the ability to make the straining effort ; later, the adhe- 
sions of a pelvic peritonitis often prevent the normal filling of the 
bladder, thus producing frequent urination. Occasionally, paraly- 
sis of the bladder arises from a swelling which renders powerless 
the bladder muscles. This may occur in diseases of the mouth of 
the uterus, in inflammation around the uterus, or in a pelvic 
peritonitis. 

Inflammation of the ovaries, or displacement of these organs, 
may occasion great pain in the bladder, or frequent urination fol- 
lowed by great pain ; next come nervous depression and conse- 
quent nutritive disorders, then danger of organic disease of the 



DISEASES OF WOMEN. . 621 

bladder unless the cause be removed. The treatment lies in re- 
moving the ovarian trouble by medicinal remedies and care, or by 
the surgical removal of the organs themselves, whereupon the 
bladder irritation will disappear. 

Organic Diseases of the Bladder. 

We have seen that many conditions give rise to symptoms 
which also belong to real bladder disease. When the bladder itself 
is diseased treatment must be applied directly to that organ. The 
simplest of the organic changes occurs in congestion of its mucous 
membrane, which, in the acute form, comes on suddenly, frequent 
painful urination being the chief symptom, though there may be 
a sense of heat and heaviness in the region of the bladder, which is 
increased by walking or standing. When the urethra is involved, 
the patient complains of the urine scalding. Usually there is no 
disturbance of the general system. 

Congestion of the Bladder is caused by exposure to cold, espe- 
cially during the menstrual period, wetting the feet, over-exertion, 
as in walking or using the sewing machine, constipation from slug- 
gishness of the portal circulation, excessive venereal indulgence, 
too free use of stimulants, and eating improper food. The treat- 
ment is warm foot baths, hot applications over the stomach, rest 
in bed with the pelvis elevated, and laxatives for the bowels if con- 
stipated. The vaginal douche of hot water often gives relief. Any 
derangement of the urine must be corrected. 

Hemorrliage from the Bladder is usually caused by some 
disease of that organ. When due to congestion, the blood may 
ooze from the free surface of the bladder, or from varicose veins 
of this organ, or from beneath the surface of the mucous mem- 
brane from places that appear as bruised spots. The blood may 
coagulate and pass in clots, or may serve to color the urine. 
Bleeding from this cause rarely prostrates the patient. The hemor- 
rhage may also be caused by malaria, cancer, ulceration and slough- 
ing of the mucous membrane, and by the hemorrhagic habit which 
is common to some women. In all cases the patient must lie still 
in bed. The treatment depends upon the cause and must be man- 
aged by a competent physician. 

Cystitis, or Inflammation of the Bladder, is quite common 
among women, and the term is usually applied to inflammation of 
the mucous membrane. The pathology of acute cystitis is the 



622 DISEASES OF WOMEN. 

same as that of inflammation of any other mucous membrane in 
the body. The surface of the bladder is reddened and covered 
with thick mucus, and some pus cells are found within the folds. 
If the bladder be allowed to be distended too long with urine, the 
entire mucous membrane may slough off. This is most apt to oc- 
cur in the retention after childbirth. 

The first symptoms are those which belong to the organ 
itself — frequent urination, pain, and pain after urination, with a 
desire to strain. Often in acute attacks there is not much, if any, 
change in the urine ; the reaction at first is acid, but changes to 
alkaline if long retained. If there be a little blood the urine will 
appear smoky, and if decomposed it will look hazy. In the chronic 
form it is of a pale, dirty yellowish hue, or it may be of a deep red 
from the presence of blood. Flakes of pus and shreds of tissue 
with more or less abundant mucus make the sediment vary in dif- 
ferent cases, and in different degrees of inflammation. 

When there is intense pain in the bladder, if the symptoms 
are caused by neighboring organs, there may be great rectal irrita- 
tion, or a congested uterus with free leucorrhea, or different forms 
of uterine inflammation; menstruation may be disturbed, there 
being too free flow from the congestion, or an entire failure of the 
period because of reflex nervous disturbance. Neuralgia of the 
uterus and ovaries may be brought on in this way. The symptoms 
referable to the general system may be abnormal ingredients in 
the blood, or a poor condition of the blood. The digestive sys- 
tem is often more or less upset, there being some nausea, especially 
at the early morning meal, a loss of appetite, and longing for pecu- 
liar foods, which, when obtained are not wanted. The nervous 
symptoms are easily explained — arising from the abnormal condi- 
tion of the blood and broken rest at night. The bowels are usually 
irregular and constipated, interrupted by attacks of diarrhea — na- 
ture's method of relieving the system of poison. The skin of a pa- 
tient with chronic cystitis is usually sallow, loose and of a lifeless 
feel. The perspiration may have a urinous odor. The causes of 
cystitis are direct injuries, blows, fractures of the pelvic bones, dis- 
placement of other pelvic organs, thus causing pressure upon the 
urethra, or dragging the bladder out of place, injury during labor, 
and violent and exciting copulation. 

Abnormal urine, if long continued, will cause cystitis even 
in a healthy mucous membrane, but very much sooner when the 



DISEASES OF WOMEN. 623 

surface is rough or tubercular. When there is an inflammation, 
mucus is thrown out to alleviate it, but this in turn is decomposed 
and then aggravates the disordered condition. Women often re- 
tain the urine too long because of lack of convenient opportunity 
to void it, and thus do themselves great injury by setting in motion 
a train of conditions leading to inflammation of the bladder. De- 
posits of the different urinary salts also irritate the mucous mem- 
brane and their continued action may promote a cystitis. Inflam- 
mation of adjacent organs may extend to the bladder, and some 
constitutional diseases, as the eruptive fevers and syphilis, may 
affect this organ. 

Drugs, improper food and the virus of gonorrhea are causes 
of inflammation of the bladder. Cantharides is an exciting drug ; 
turpentine and arsenic will produce active congestion; alcoholic 
beverages, continued a long time, give rise to a low grade of 
cystitis; and large doses of the chlorate of potash may cause an 
active cystitis. Foods will not cause inflammation in a healthy 
bladder, but may irritate an unhealthy one, hence all irritating con- 
diments, alcohol, asparagus, onions, etc., are better avoided in 
these diseases. 

Treatment . — This disorder requires local, as well as con- 
stitutional treatment. In this connection, as elsewhere, only the 
milder forms of treatment will be mentioned. Rest is always nec- 
essary. The urine must be so modified as to alleviate irritation 
and pain as far as possible. The skin should be kept in a healthy 
and active condition, and the bowels open and free. Much benefit 
is derived from the use of salts to the securing of great looseness 
of the bowels. Indigestion, malnutrition from any cause, gouty, 
tuberculous and rheumatic tendencies, all aggravate cystitis and 
must be treated in order to relieve a case caused by these condi- 
tions. It is very important that a large quantity of pure water be 
taken ; milk is of great advantage, and a milk diet has been known 
to entirely cure some cases. Not more than a pint of it must be 
taken at one time. Milk agrees better with some if boiled, than 
taken either cold or tepid ; and some are able to take a gallon of it 
per day. If the cream disagrees, skimmed milk should be used, 
and, when the bladder irritation has disappeared, gradual return 
may be made to a solid diet by combining food with the milk in 
various proportions. 

In the beginning of an acute attack, vichy water or flaxseed 



624 



DISEASES OF WOMEN.' 



tea will answer well. The infusion of buchu always acts favorably 
when it can be borne by the stomach, or the fluid extract of buchu 
in teaspoonful doses once in two or three hours may be used in- 
stead. The benzoate of ammonia, in ten-grain closes, acts well 
in proper cases. There are many other drugs which give great re- 
lief and restore to health, but they must be administered by the 

physician. 

THE MENOPAUSE. 

The menopause or permanent suspension of the menstrual 
function is usually known as the change of life. It usually occurs 
between the ages of forty-five and fifty-five; it may come earlier 
or later than these limits; the average is at fifty. It does not 
follow that because the menstrual function began early in the 
life of an individual it will therefore cease early. To women in 
good health the approach of the menopause is heralded by a les- 
sening of the time of the periods, with a gradual diminution of the 
amount of the flow, then a period may be missed, followed again 
by regular periods for a few times, and then the flow ceases en- 
tirely. In other cases six weeks may intervene between the pe- 
riods, which, when they do occur, are inclined to be excessive. The 
time consumed in the change to complete cessation varies from 
six months to two years, and sometimes more. 

Being a natural phenomenon the menopause ought not to 
cause ill health, but there are manifestations of discomfort, due 
to the change in the circulation and the cessation of the functional 
activities of the generative organs. Many increase in flesh and 
become more or less inactive, both physically and mentally. 
There may be functional disturbances of the heart and digestive 
organs and deranged secretions. The flushing of the face and 
hot flashes, due to vasomotor disturbances, are very annoying. 
Fullness of the head, occasional headaches and sleeplessness at 
night are sometimes noticed, and in some cases there is a slight 
loss of appetite, and with it a loss of weight. In some there is dis- 
turbance of the circulation, nervous excitement, restlessness and 
impaired memory from lack of concentration. These are common 
symptoms in healthy women under ordinary circumstances at this 
time in life. 

The change in the sexual organs is a gradual breaking down 
and diminution in size until when the menopause is completed the 
uterus is no larger than that of a child, and the ovaries cor- 



. DISEASES OF WOMEN. 025 

respond with it in size. With each ovulation, the ovaries have 
gradually deteriorated, and now no longer exert an influence 
over the animal economy. There is not as great a demand for a 
large blood supply, and the uterus soon shows the effect of the low- 
ered nutrition by diminution in size. There is lowered nutrition 
of the external nerve centers, and the organic nerves which 
govern them, and to some extent the brain also withdraws its 
influence. With this change menstruation ends. 

Certain diseases may keep up a modified menstruation, thus 
draining the nervous and nutritive systems ; again, degeneration of 
the ovaries and uterus may cause suppression of the menses 
while the cerebro-spinal system is yet very active, and a dis- 
turbance of equilibrium with attendant ill symptoms follow. 

Treatment is necessary to quiet mental disturbance and secure 
proper rest. Sedatives and tonics have their place. For the di- 
gestive disturbances subnitrate of bismuth in twenty-grain doses 
is often an efficient remedy. The spinal irritation is relieved by 
cupping, and by cold and hot douches alternating. Time is an 
effective cure, so alleviation of the disagreeable features is all that 
is necessary. When there are marked symptoms of plethora, with 
inactive kidneys and liver, small doses of calomel followed by a 
dose of saline water, or draughts of a natural cathartic water, are 
helps. Turkish baths and muscular exercise do good in some 
cases. The diet should consist of milk, eggs and vegetables; 
very little meat is to be taken, and the quantity of food must be 
limited; under-eat rather than over-eat. As there is a tendency 
to develop diseases of the nervous system at this time, it is of 
manifest importance to regulate all imperfections as far as possible. 

When a woman is strong and healthy there is no reason for 
alarm if the menopause is delayed, but when the general health 
is impaired and the menopause extends beyond the usual time 
effort should be made to discover whether any local cause for it 
exists. Any tumor, a failure of the uterus to return to its normal 
size after labor, or old injuries, may keep up the menstrual flow. 
Scar tissue in the cervix, by keeping up irritation, may prevent 
the normal change. Liver, heart or kidney disease may prolong 
menstruation and give rise to increased hemorrhage about the 
time of the menopause. These conditions should all receive 
proper treatment, which, if successful, will relieve the increased or 
prolonged hemorrhage. 

40 



626 DISEASES OF WOMEN. 

INFLAMMATION OF THE UTERUS AFTER THE MENOPAUSE. 

This deserves special notice, because it is not only of frequent 
occurrence, but varies from that of youth and middle life in being 
more of a degeneration than inflammation, and only yields to 
most persistent local treatment. These cases of endometritis 
after the menopause usually follow endometritis before the meno- 
pause, or are kept up by displacements, old lacerations, or small 
tumors, which, even when removed, may leave an irritation 
behind that takes a long time to heal ; in fact, the cure in all these 
cases requires patient and protracted treatment. 

Particular attention must be given to diet and general tonics, 
and much relief is obtained from vaginal douches containing from 
two to three drams of powdered borax to the quart of water, or one 
dram of sulphate of zinc to the quart of water. If all the local 
treatment to which the physician may resort fails, there may 
arise the question of complete removal of the uterus by surgery. 

ABDOMINAL DISPLACEMENT. 

It must be observed that very frequently there develops in 
the aged a tendency to failing not only of the uterus, but also of 
the abdominal contents, which then push down the uterus before 
them. The cause of this is wrong use of corsets and predisposition 
to displacement. Bending over, as in reading, writing and the 
use of the sewing machine, actually produces this displacement for 
the time, but when the constriction is removed, or the nor- 
mal position is again resumed, there is a return of the 
abdominal contents to their proper place. In old age, 
however, this elasticity of tissue is lost and the dislocation 
persists. Replacement is obtained by manipulation with the 
fingers and a position upon the back in which the hips are higher 
than any other part of the body. This replacement is retained by 
rest in bed and by an abdominal bandage. When improvement 
is noticed the patient may be allowed to sit up, the clothing about 
the waist being very loose. The knee-chest position should be 
practiced several times daily, and a few short rests taken in the 
reclining position ; the bowels should be kept free ; massage, 
electricity and tonic treatment are here of great benefit. Complete 
relief will be obtained by young women, but in the old this is 
seldom attained. 



DISEASES OE WOMEN. 627 

COMPLETE PROLAPSUS. 

In aged women complete prolapsus, or falling of the womb, 
is also frequent. It comes from degeneration of the tissues of 
the pelvic cavity. This may be preceded by lacerations and in- 
flammation during earlier years, or be found in those who develop 
displacements after the menopause. Sedentary habits and im- 
paired nutrition are the chief predisposing causes, and constipation 
and delay in emptying the bladder are aids in bringing on the dis- 
ease. It is often found in those who have been obliged to be a 
great deal upon their feet. 

Treatment. — It is far easier to prevent prolapsus than to 
cure it. When the first symptoms of bearing down and of irri- 
table bladder are noticed, astringent douches should be given, a 
teaspoonful of sulphate of zinc to the quart of hot water, or a table- 
spoonful of tannic acid to the quart of hot water. Later in the 
disease it is often necessary to use plegets of cotton medicated 
with glycerin and tannic acid — two teaspoons of tannic acid to a 
tablespoon of glycerin. These plegets must be of just the right 
size to give support and not irritate. Pessaries often answer re- 
markably well if properly fitted and give no pain or inconvenience 
by their presence. They should never be worn if the patient is at 
all conscious of their presence. 

ENLARGED PELVIC VEINS. 

The pelvic veins are especially prone to dilatation because 
they are without valves or support by fasciae or tissues, and are 
under constant pressure when the woman is in the erect position. 
These enlarged veins cause pressure upon the pelvic tissues and 
nerves, and are thus a source of dull pain. This derangement of 
the circulation, if continued, will sooner or later result in disease 
of the ovaries, rectum, uterus and bladder. The causes are un- 
suitable occupation, tight clothing, excessive activity of the 
sexual function without satisfaction, lacerations, and a lack of 
return of the uterus after childbearing or miscarriage. Any con- 
dition that obstructs the return of the blood from the pelvis 
favors this condition. 

Treatment. — Many of these cases can be greatly relieved by 
rest in bed with the hips elevated. Astringent douches, restora- 
tion of all lacerations, plegets medicated with tannic acid and 
glycerin, pessaries, all are useful. At night the pelvis should 



628 ' DISEASES OF WOMEN. 

be raised, and when on the side, Sims position should be taken, the 
upper knee being placed on the bed above the lower knee. Elec- 
tricity is also valuable in these cases. 

If women would consult the physician as soon as the earlier 
symptoms of pelvic disease present themselves, submit to the 
proper course of treatment, and follow instructions not only in the 
medicinal line, but with regard to rest as well, many months of 
suffering would be avoided, and healthy womanhood result. 



DISEASES OF THE SKIN. 

By R. E. McVey, M.D. 

CHAPTER I. 

ANATOMY. 

A knowledge of the structure of the skin is very important 
to those who expect to understand the nature of its diseases. 

The skin is divided into the outer or scarf skin and the inner 
or true skin. The scarf skin is divided into the horny and the 
mucous layers, which are for the protection of the true skin under- 
neath. The true skin is a flexible and highly elastic tissue, a part 
of whose purpose is to defend the parts beneath from violence. It 
also is divided into two layers, the papillary and the reticular. 
The papillary layer is the superficial or outer of these two layers 
and contains the nerves of sensation and the small blood vessels 
from which the scarf skin draws its nutrition. The reticular 
layer is composed of connective tissue and contains the sebaceous 
and sweat glands and the hair follicles. The openings of these 
glands and follicles extend upward or outward through the other 
layers to the surface of the scarf skin. 

The skin varies in thickness, being thinnest upon the eyelids, 
the prepuce and the inner surface of the greater labia, and thickest 
upon the back, soles and palms. The subdermic tissue (tissue 
found beneath the true skin) is composed of connective tissue so 
arranged as to form a network, enclosing fat cells, which have thin 
elastic capsules or sheaths. These fat cells are separated, one 
from another, by the connective tissue fibers and are furnished 
with a capillary plexus, or network, having an afferent artery and 
two or three efferent veins. When abundant, this adipose 
structure beneath the skin gives to the features of young people 
their symmetrical and healthful appearance. Connective tissue is 
also found in the corium, or true skin, but to only a limited ex- 
tent. 

The sebaceous or oil glands pour out a secretion for the 

629 



630 DISEASES OF THE SKIN. 

purpose of keeping the skin moist, giving to the hair its oily 
and glossy appearance, and protecting the skin against the ab- 
sorption of excessive amounts of fluids and moisture, which other- 
wise might reach the circulation. 

The sweat glands give off perspiration, and daily pour out 
about a quart of watery fluid containing some two per cent of 
solids, chiefly chloride of sodium, some fat, some cholesterine, urea 
carbonates, phosphates and organic acids.' Sweating is probably 
more or less under nerve control and is the result of some stimulus 
acting upon the surface of the skin and reflected to a spinal center. 

The skin is abundantly supplied with blood vessels, there being 
two distinct, parallel, horizontal sets; one in the true skin just 
beneath the papillae, which receive nourishment from it through 
their vascular loops; the other below, in the connective tissue of 
the reticular layer, among the fat and sweat coils. 

The muscles of the skin are of both varieties, the striated 
and the smooth. The striated are found only in the face, neck, 
chin, lips, nose and eyebrows. The smooth muscles are found in 
connection with the hair follicles and sebaceous glands and are 
arranged in bundles. The hair muscles (arrectores piiorum) 
spring from the papillary layer and pass to their insertion in the 
middle of the hair follicles to which they are fixed or joined. These 
muscles are surrounded and crossed by a network of elastic 
fibers through which their action is transmitted. They are very 
abundant upon the scalp and their contraction and movement are 
favored by their lying in lymph spaces. Their general contraction 
over the surface of the body produces what is known as goose skin 
(cutis anserina). 

These erector hair muscles also regulate the secretions and 
excretions of the skin, and furnish a protection against alterations 
of temperature, by causing contraction and thickening of the 
skin to prevent the action of cold, dampness and other deleterious 
effects. 

Pigmentation of the skin depends upon a slight staining in 
the lower layer of cells in the rete (reticular layer). The true 
pigment is known as melanin and is found in fine granules, de- 
posited in the cells to which we have just referred. Its color is 
modified by the vascularity of the skin and the coloring matter 
of the blood. The sun has much to do with its color and quantity. 
Thus, in cold climates it is of light color and shades into deeper 



DISEASES OF THE SKIN. 631 

and deeper hues as we go toward the equator, until a deep black 
is reached, as found in the negro. The inference was the exist- 
ence of some relation between pigment and the rays of the sun, and 
it has been proven that pigment is protection against heat rays. 

DEFINITIONS. 

The following terms are used in discussing skin diseases and 
a little study of them will greatly aid in understanding their diag- 
nosis. 

A red spot upon the skin, due to a superabundant supply of 
blood in that part, is called erythema, and the oversupply causing 
it, and resulting in distention of the arteries and veins, is called 
hyperemia. 

A papule is a pimple, a small, solid elevation, not often larger 
than a split pea and located upon the surface of the skin. When 
deep seated it is called a tubercle. Such solid masses larger than 
a tubercle, but smaller than a cherry, are called nodules. If larger 
than cherries they are called tumors. 

Vesicles are small, cone-shaped elevations containing straw 
colored fluid. Blebs or bullae are large vesicles, such as are met 
in cases of ivy poisoning. 

Pustules are small elevations containing pus or matter. A 
vesicle in its later stages may become a pustule. 

An eruption consisting of pustules is called pustular, of pa- 
pules papular, and of mere dots or points punctate. 

Wheals are variously sized and shaped swellings, whitish or 
reddish in color, usually pale at the center, and appear and dis- 
appear quickly, as the lesions produced by mosquito bites, the 
sting of a nettle, etc. 

Squamae are scales of the epidermis or scarf skin. They are 
sometimes called epithelial scales. Desquamation is the term 
used to denote a natural casting off or loss of these scales. 

Crusts or scabs are hard masses of dried pus, or other exuded 
fluids, and dead skin. 

Excoriations are portions of the skin denuded of epidermis 
by chafing, rubbing, scratching, etc. 

Ulceration is destruction of a portion of the skin by disease 
through suppuration — the formation of pus. 

Fissure is a crack in the skin, such as occurs in cracked lips 
or chapped hands. Cicatrix is a scar. Stains are discolorations 
left by skin disease and may be either transitory or permanent. 



632 DISEASES OF THE SKIN. 

A lesion is a hurt, injury or sore. A secondary lesion is one 
resulting from another or primary lesion through accidental or 
natural change, modification or termination. 

Scales, crusts, excoriations, fissures, ulcers, scars and stains 
are all included in the general term secondary lesions. 

It is a mistake to suppose that all skin diseases are results 
of bad or impure blood, or that it will not do to heal them too 
quickly. Like other disorders of the body, they should be cured 
as quickly as possible. 



CHAPTER II. 

DISEASES OF THE SEBACEOUS GLANDS. 

The sebaceous or oil glands secrete sebum, which consists 
of water, cast-off epithelial structures, fatty and granular matter, 
alkaline and earthy phosphates, chlorides, palmitin, olein and 
cholesterine. 

There are three sets of sebaceous glands situated within the 
true skin. 

Some occur as appendages of the hair system and are desig- 
nated as glands of the hair follicles. The smaller set are append- 
ages of the long hairs. The larger set are mostly found over those 
regions of the body covered with lanugo hairs. The third, al- 
though a variety of hair follicles, occur quite independently of the 
hairs and are known as the glandulae odoriferae of the genitals in 
both sexes. 

The Meibomian glands are situated about the eyelids and 
are liable to inflammation, injuries and pus formations, such as 
sties, for which all the treatment needed is an opening up of the 
glands affected. 

The arrectores pilorum are follicular muscles, which, by their 
extension and contraction, undoubtedly aid in forcing out the 
sebaceous matter from the ducts. 

When the secretions are not eliminated, but collect in the 
ducts, the disease is known as comedo. 

When little cysts form in the ducts and contain a little white, 
hard, seed-like substance it is known as milium. 

When cysts form in the ducts and grow to a large size, 
whether their contents be hard, soft, cheesy or fluid, they are 
called steatoma. 

When the secretions are increased the disease is known as 
seborrhea. 

When the secretions back up at the gland outlets and de- 
compose the condition is known as acne. 

When the secretions are diminished the disease is called 
asteatosis. 

633 



634 DISEASES OF THE SKIN. 

COMEDO. 
(Black Heads. Flesh Worms.) 

The comedo (dermodex folliculum) is a small parasite which is 
found in the sebaceous glands. Its favorite sites are the nose, chin, 
forehead, cheeks, etc., but it has also been observed in many other 
parts of the body. 

The parasite rests with the head downward in the follicle and 
is easily pressed out from the large glands of the nose by a curette, 
or by pinching them between the thumb nails. It is not known to 
have any injurious effect, but its presence is, by some, considered 
the first stage of acne. No treatment is needed except to press 
them out and paint the parts with fluid extract of ergot, or a 
saturated solution of boric acid. 

MILIUM. 
(Grutum.) 

Milia are small, pearly, whitish or yellowish globular bodies 
lying just below the surface of the skin. They are not painful, are 
pin head in size and most common in the face, just below the eyes, 
but are also found on other parts of the skin. Each of these little 
bodies is an abnormal development of a sebaceous cyst whose out- 
let became clogged so that its secretion was retained and becam< 
dry and hard. 

Treatment. — Electrolysis is probably the best, but if that is 
not convenient break a coarse needle, sharpen the shaft to a chisel- 
shaped edge and with it prick each globule and press out the con- 
tents. Should they reappear repeat the treatment and touch each 
cavity with tincture of iodine. 

STEATOMA. 

(Wens.) 

A wen has sometimes been called a large milium. Both af- 
fections are probably due to the same cause, but they differ much 
in character and development. The contents of a wen may be 
hard, soft, cheesy or fluid. It is usually found upon the face, scalp 
or back, and is movable and painless. 

Treatment. — A long incision is made and the mass dissected 
out, care being taken to remove the enveloping sac, for if that be 
left the growth will be very sure to return. 



DISEASES OF THE SKIN. 635 

SEBORRHEA. 

(Dandruff.) 

Seborrhea is an affection of the sebaceous glands, character- 
ized by an increased flow of their secretion. It may be divided 
into two classes, that of the hairy parts and that of the smooth 
parts of the body. Seborrhea of the hairy parts is divided into 
four varieties : dry, concrete, oily and circinate. 

Dry seborrhea is really an excessive amount of epithelium of 
the scalp and is not properly a disease of the sebaceous glands, but 
of the epithelium of the scarf skin. It is often called dry skin. 

Concrete seborrhea is composed of greasy crusts formed from 
sebum and epithelial scales. The crust varies from a grayish white 
to a deep brown, and is adherent to the scalp. Under the crust 
is a reddish moist surface. This form of seborrhea is found upon 
the scalp in the region of the temples, and may pass a little below 
the hairy border of the temples. 

Oily seborrhea, also known as seborrhea oleosa, greasy sebor- 
rhea, or oily skin, is a mixed form of seborrhea and shows itself 
upon the scalp and at the same time upon the face by a layer of 
oily, greasy matter in greater or less abundance. The skin is 
more or less red and congested. 

Circinate seborrhea, eczema of the scalp, is probably a para- 
sitic disease and should be classified as an eczema. It is char- 
acterized by the appearance of greasy scales or crusts arranged in 
figure-of-eight forms., resting upon a red base, sometimes dry and 
sometimes moist. There is usually found an oozing or weeping 
surface from the scabage raised. Upon the top of the scalp there 
is more or less alopecia or baldness. This form of eruption is also 
found upon the trunk, between the shoulders, and upon the 
sternum. When found upon the body it is called seborrhea cor- 
poris. It is also known as lichen annnlatus serpiginosns. 

Baldness is observed in all the varieties of seborrhea. It does 
not originate at the same time as the disease, but follows it after 
a longer or shorter period. 

In the first two forms, which are the kinds most frequently 
met. two stages may be observed. In the first stage there is more 
or less scaling, and the hairs are dry, thin and gradually fall out — 
the duration of the condition varying, according to the subject, 
from one to ten years. 

In the second stage the hair falls rapidly. It becomes more 



636 DISEASES OF THE SKIN. 

and more thin and fine, until there remains only a downy growth, 
which in turn also vanishes. 

These two forms affect men between the ages of twenty and 
thirty-five years. Sometimes this form of baldness is seen in 
women also. The disease sometimes attacks the eyelashes and 
brows, producing alopecia of the lids and brows. Seborrhea of 
the scalp may be complicated by various other affections. 

Cause of seborrhea : General debility, anemia, chlorosis, dys- 
pepsia and loss of tone in the glands and skin. It may be 
parasitic and contagious, but the parasite has not yet been dis- 
covered. 

Diagnosis. — Seborrhea of the scalp may be confused with 
eczema and psoriasis. Upon the face it may be confounded with 
lupus erythematosis and eczema, and upon the trunk with psoria- 
sis and ring worm, but eczema, psoriasis and erythematosis are 
diseases in which there are more or less inflammatory symptoms, 
such as thickening, infiltration and redness. These do not occur 
in seborrhea. 

All the types are curable and those upon the non-hairy por- 
tions of the body readily so. Those upon the hairy parts are ob- 
stinate. In cases of seborrhea of the scalp, which have been of 
long standing or neglected, attended with loss of hair, the loss 
may be more or less permanent. 

Treatment. — Various tonics are recommended, such as iron, 
quinine, strychnia, cod liver oil, arsenic and maltine in its various 
forms. Shampoo with castile soap and hot soft water. When 
there are scales and crust formations the tincture of green soap 
should be used. Previous to shampooing, the scalp should be 
soaked with olive oil. The head should be kept clean. The treat- 
ment may be repeated every day, or every other day, according to 
the rapidity of the formation of scales or crusts. The affected 
parts may be anointed with petroleum ointment, or bathed with 
a lotion composed of ten drops of glycerin to one ounce of dilute 
alcohol. Water may be used in place of the alcohol, but is not as 
good. 

Any of the following ointments are useful : One dram sul- 
phur to one ounce of lard ; 26 grains ammoniated mercury to an 
ounce lard ; 30 grains salicylic acid to an ounce lard ; 26 grains 
resorcin to an ounce lard. Vaseline is preferred to lard, by some, 
for use in these ointments, but its medicinal properties are not as 



DISEASES OF THE SKIN. 637 

valuable. The following lotion is also used with good results : 
Resorcin i dram, castor oil 20 drops, alcohol 4 ounces. 

Do not use a stiff brush or a fine comb on scalps affected with 
this disease to remove dandruff, for they will only make the trouble 
worse. Only a very soft brush should be applied. 

ACNE VULGARIS. 

Acne vulgaris is a chronic, inflammatory affection of the se- 
baceous glands, caused by decomposition, or a backing up of the 
secretion of the glands at their outlets. The disease makes its ap- 
pearance about the fifteenth year, when the development or 
changes in the glands in general take place. In such persons we 
find more or less general debility, accompanied by dyspeptic 
symptoms and irregular habits of the bowels. 

The loss of tone in the muscular fibers of the glands of the 
skin is an effect from the general debility of the system. This 
general muscular debility is probably associated with a modified 
nervous tone through which the secretion in the glands undergoes 
chemical changes which give rise to hyperemia and inflammation 
in the follicles. 

When the inflammation in the glands is intense and red it is 
designated as acne punctata. 

When the eruption is a little more elevated we call it acne 
papulosa. 

If the base of the eruption is red and hard it is called acne 
indurata. 

If pus forms in the center of the papule it is designated as 
acne pustulosa. 

If the lesion disappears, leaving a pit-like depression, it is 
known as acne atrophica. 

When there is connective tissue, new growth, it is known as 
acne hypertrophica. 

In scrofulous or cachectic individuals, where there are dermic 
abscesses of a cold and sluggish character, it is called acne cachec- 
ticorum. 

Temporary acne is produced by certain medicines, such as the 
bromides, the iodines and the external use of tar. 

Acne is usually an obstinate disease but curable. Sometimes 
it yields readily to treatment, but at other times is very rebellious. 
Each case must be studied and treated by itself, as the indications 
demand. It is most common in persons of light complexion. 



688, DISEASES OF THE SKIN. 

For the general debility, bitter tonics, alkalies, acids^ pepsin 
and saline and vegetable laxatives are prescribed, as their use is 
indicated by the various alterations in the digestive secretions. A 
very good remedy is : 

Fluid extract cascara sagrada two drams 

Tincture nux vomica two drams 

Tincture gentian comp three and one-half ounces 

Take one teaspoonful three times a day. 

Equal parts of sulphate of iron and carbonate of potassium, 
powdered and well mixed, form a good remedy. It should be 
taken in two-grain doses three times daily. 

For anemic patients preparations of iron are recommended; 
and for scrofulous and debilitated subjects cod-liver oil is of great 
value. Where there is a tendency to the pustular form of the 
eruption, Calx sulphurata in pill form, one-tenth of a grain four 
times a day, should be taken. 

Females who have uterine disturbances in connection with 
this disease may be given fifteen drops of the fluid extract of 
ergot three times a day. 

In the slow, sluggish, papular form arsenic is invaluable. 
Probably arseniated soda, one-twentieth of a grain three times 
daily, is the best. Washing the parts with warm water and soap, 
then rinsing and sponging for several minutes with hot water, is 
very important. In sluggish and non-irritable cases green soap 
should be used in place of ordinary toilet soap. If ointments are 
used they should be rubbed in thoroughly. 

The following stock prescriptions are excellent : 

Sulphur (precip) one dram 

Benzoinated lard two drams 

Lanolin two drams 

If a lotion is preferred use 

Sulphur (precip.) one and one-half drams 

Pulverized gum tragacanth twenty grains 

Spirits camphor two drams 

Lime water. . . . . .three and one-half ounces 

Or Sulphur (precip.) one and one-half drams 

Ether four drams 

Alcohol three and one-half ounces 

Resorcin,6o grains to an ounce of distilled water, is sometimes 
very good. All external applications should be used twice a day. 



DISEASES OF THE SKIN. 639 

PSORIASIS. 

Psoriasis is a chronic inflammatory affection of the skin and is 
distinguished by red, roundish patches covered by silvery scales. 
The disease is usually found upon the scalp, elbows and extensor 
muscles. The affection begins as a small papule and enlarges at 
the margins. According to the development of the papules the 
disease is known as psoriasis punctata, psoriasis guttata, psoriasis 
nummularis, psoriasis circinata and psoriasis gyrata, but we will 
here consider it under the general term psoriasis. 

It is not a contagious disease and is more common in winter 
than in summer. Sometimes it disappears altogether in warm 
weather, only to come again when winter returns. Various 
theories have been advanced as to its cause. Some eminent 
authorities believe it to be of microbic origin. If so, the microbe 
does not enter from without, but finds its way into the capillaries 
of the papillary layer through the blood. This view is strength- 
ened by the fact that microbes have been found in the scales. 

Some think it a hyperplasia of the cells of the rete, the over- 
production of epithelial cells setting up inflammation. Still others 
believe that it is due to a functional weakness of the nervous centers 
regulating the nutrition of the skin and that the eruption depends 
upon local irritation ; that the hat may have something to do with 
its presence upon the scalp ; that its presence upon the elbows and 
knees and the surface of the extensor muscles is the result of some 
form of irritation, etc. 

A strong diagnostic feature of psoriasis is the absence of dis- 
charge. The skin is dry through the whole course of the disease. 
The affection that most resembles it is eczema squamosum, but 
the eczema patches are seldom well defined, while those of psoria- 
sis are. In psoriasis the scales are in a single layer, while those of 
eczema are in an adherent crust. The eczema crusts are composed 
not of scales only, but of dried exudation mixed with scales, and if 
these crusts are removed forcibly, an exudation of serum is more 
likely to ensue than one of blood, and bright red points are not 
seen in the exposed surface. 

In lichen planus the patches resemble those of psoriasis, but in 
lichen planus they are common on the front of the leg, the scales 
are not in crusts, the infiltration is greater as a rule, the color of the 
eruption is a violet red, and the papules are flat and angular. 



640 DISEASES OF THE SKIN. 

Psoriasis also differs from seborrhea of the scalp, in that the 
latter is more diffuse, without redness and infiltration, and has 
greasy scales of a dirty gray or brownish color, while, the scales of 
psoriasis are dry and whitish or of a mother-of-pearl color. 

Treat7nent. — Arsenic is an old remedy for the sluggish and 
chronic forms of this disease. It is given in the form of Fowler's 
solution, two to five drops three times a day. Arsenic should 
never be given alone. If we wish to give two drops of the solution 
three times a day the best way is to put one dram of it into four 
ounces of water and give a teaspoonful. 

Potassium iodide is a valuable remedy for this disease where 
there is a specific taint in ancestors. Salacine has given good re- 
sults and salicylate of soda is good, if we take the view of it being 
of microbic origin. Iron, quinine, strychnia and cod-liver oil are 
recommended if there be general debility. The scales may ordi- 
narily be removed by alkaline baths, or by washing in hot water 
and soap, after which either of the following external remedies 
may be applied. 

Vaseline one ounce 

Chrysarobin one-half dram 

Salicylic acid one-half dram 

Resorcin one dram 

Or Ichthyol three drams 

Bismuth subnitrate one dram 

Vaseline one and one-half ounces 

A 25 per cent solution of resorcin is a valuable lotion for this 
purpose. 

The patient should be kept under observation and the treat- 
ment varied according to the intensity of the inflammation. The 
use of chrysarobin is likely to stain the clothes, and, when used 
about the head, to produce irritation of the eyes; hence, it is better 
to confine the treatment to salicylic acid or pyrogalic acid, using it 
in the prescription instead of chrysarobin, but the latter is the 
best remedy aside from these qualities. The disease is very obsti- 
nate, and, under any form of treatment, will return from time t( 
time. 



DISEASES OF THE SKIN. 641 

LICHEN PLANUS. 

Lichen planus is an inflammatory affection of the skin. It 
appears in red or violet colored, flat, angular papules, and is 
usually found on the front surface of the wrists, the forearms, the 
lower part of the abdomen, the back, neck, lower extremities, 
genitals, sides of the trunk, palms and soles. It also occurs inside 
the cheeks and upon the scalp. The papules run an unchangeable 
course, never contain any fluid, and may be separate and distinct 
or may run together. 

This disease does its work very slowly, and may persist with- 
out change for many months or years. The eruption spreads 
slowly, but progressively; sometimes there is slight inflammation, 
and sometimes changes which seem to coincide with mental 
shocks and over-fatigue, or some disturbance of the nervous sys- 
tem. Left to itself, lichen planus may undergo spontaneous cure, 
but usually it lingers long. The papules undergo a gradual de- 
cline and their centers become depressed and colored, there being 
considerable coloring matter left after the eruption has dis- 
appeared. 

It may be distinguished from papulary eczema by the an- 
gularity and flatness of its lesions, their peculiar purplish red color, 
and the absence of minute blood crusts. From psoriasis it differs 
in possessing no tendency to the formation of gradually increasing 
circular patches, nor to the accumulation of epidermic scales. Un- 
less his nerves are very badly disordered, a person afflicted with 
lichen planus will always recover. He should be informed as to 
the severity of the disease and its variable course. Beyond the 
annoyance from the itching, and the unsightly appearance of the 
eruption on the exposed parts, one need expect no serious dis- 
comfort, for in bad cases the general health suffers but slightly. 

Treatment. — Arsenic is the sovereign remedy in this disease, 
and should be ^iven in water, in the form of Fowler's solution. To 
one dram of the solution add four ounces of distilled water, shake 
thoroughly, and take two teaspoonfuls three times a day, after 
meals. The best local remedy is the following wash which should 
be used twice a day: Zinc sulphate one-half dram, sulphuret of 
potassium one-half dram and rose water four ounces. 



41 



642 DISEASES OF THE SKIN. 

URTICARIA. 
(Nettle Rash. Hives.) 

Urticaria, from the Latin word for nettle, is an inflammatory 
affection of the skin, characterized by firm, smooth, round, oval 
or irregular shaped wheals, moderately elevated, having reddened 
bases and flattened tops, which, as the wheals develop, usually lade 
to whitish centers. Each wheal is small at first, but rapidly en- 
larges to an area from one-fourth to one inch in diameter, and has 
such itching, pricking or stinging sensations as to generally lead 
to severe scratching, but this relief is only temporary, is soon fol- 
lowed by greater suffering and, sometimes, by the formation of 
new lesions as troublesome as the first. It is thought that the 
disorder is of nervous origin, for the wheals come and go, lasting 
from an hour or two to a day or even longer, then disappearing, 
leaving no scales or traces of any kind. The health of the gouty 
is often improved by an attack, but one having had hives once 
is more likely to have them again. 

The occurrence of urticaria implies a peculiar predisposition 
of the individual to the disease, and where this is well marked the 
attacks may be brought on by almost any form of friction of the 
skin, as the chafing of coarse garments on the knees or other parts. 
It may also be induced by the action of heat and cold. Among its 
internal causes are emotional excitement, hysteria, digestive dis- 
turbances and certain articles of food, such as fish, crabs, lobsters, 
clams, oysters, pork, mutton, cheese, and sometimes eggs, cu- 
cumbers and strawberries. Hives in children is probably due to 
the same cause. 

Treatment. — Salicylate of soda has a valuable effect upon the 
disease when associated with rheumatic conditions. From five to 
ten grains may be given every four hours to adults, and in smaller 
doses to children. When accompanied by irritation of the in- 
testines, salts or other saline cathartics should be given. Where 
there is much itching, atropine may be given in doses of one one- 
hundred and fiftieth of a grain once in four hours. It first pro- 
duces constriction of the blood vessels, but its secondary effect is 
that of dilatation, thus relieving the spasm of the muscles of the 
skin. Through a similar action hot water or a Turkish bath is 
sometimes successfully employed. Vinegar and water, lemon 
juice, diluted acetic acid, diluted alcohol, or peppermint in alcohol, 
three grains of the former to an ounce of the latter, any of them, 



DISEASES OF THE SKIN. 643 

may be applied externally. Dusting powders of starch and zinc 
oxide applied after an alkaline bath are useful. Those predisposed 
to the disease should guard against those articles of food that are 
likely to arouse it. 

HERPES SIMPLEX. 
(Fever Blisters.) 

Herpes simplex is an acute, noncontagious, benign affection 
of the skin, occurring in one or more groups of vesicles on a 
reddened base, and usually accompanies some other disease. 

There are two varieties, herpes facialis and herpes progeni- 
talis. The eruption is preceded by malaise or some constitutional 
disorder. The sense of chilliness or shivers precedes, and within 
a few hours a papular eruption develops which is readily trans- 
formed into vesicles. These are from pin head to pea size and 
stand closely together in groups, five or six forming a patch in 
some cases, but usually not more than one or two. The eruption 
is most often found around the mouth, particular!)' upon the lips 
near the junction of the skin and mucous membrane. When so 
located it is called herpes labialis ; when on the side of the nose, 
herpes nasalis ; when upon the genitals, herpes progenitalis, and 
is divided into herpes preputialis and herpes vulvae. 

Herpes simplex, or fever blisters, usually disappear in a few 
days, but may remain two weeks. Anointing the parts with cam- 
phorated cold cream relieves the burning. Applications of spirits 
of camphor or any similar lotion is also useful in hastening the 
termination of the trouble. Subnitrate of bismuth rubbed upon 
the eruption is excellent. 

Herpes progenitalis is common in the uncleanly after inter- 
course, occurs upon the genitals, is more frequent in men than in 
women, and usually follows some disordered condition of the 
system. It is sometimes preceded by chancroid or gonorrhea, 
coming out two or three weeks after the sore has been healed or 
the gonorrhea cured, and recurring quite regularly every few 
weeks or months thereafter, especially if the organs be excited 
as by coitus or the use of the catheter, but it may follow any of 
the causes that produce herpes upon the lips. It is probably a 
result of disordered nerves, but this has not been proven. Its 
diagnosis is important because it is often mistaken for chancroid. 
At the beginning no one should make this mistake, for this herpes 



644 DISEASES OF THE SKIN. 

then very closely resembles the other form in which the fever 
blisters or cold sores appear on the lips and is preceded by simi- 
lar symptoms — itching or burning in the swollen spots that be- 
come the sites of the blisters which nearly always/begin as a cluster 
of small vesicles; but after two or three days pus forms in the 
sores and it may be that time alone can then positively decide, 
although chancroid usually begins as a single vesicle and about 
four days after exposure through sexual contact. If in three or 
four days more the blisters heal, the trouble was herpes, for chan- 
croid spreads through self-inoculation, has greater destructive 
tendencies and recovers more slowly. Herpes could hardly be 
mistaken for the initial lesion of syphilis, since the latter almost 
always is a single small sore which matures slowly, hardens and 
secretes very little serous fluid, and is accompanied by enlarge- 
ment of the glands in the groins. 

Treatment. —Proper hygiene of the parts; strict cleanliness; 
the separation of the opposing surfaces by slightly astringent and 
aseptic powders; regulation of the sexual habits, and, in men, 
sometimes circumcision. 

HERPES ZOSTER. 

(Shii'gles.) 

Herpes zoster is an acute, inflammatory disease in which the 
vesicles are tense and firm and situated upon inflammatory bases. 
The vesicles are closely pushed together and grouped into patches. 
They are at first filled with a clear fluid, which may soon take 
on a milky or yellowish appearance from the production of pus 
corpuscles. The lesions run together, bullae are formed, and large 
patches of skin become elevated. As the groups may not all come 
out at once, a few are likely to be seen at first. New ones begin 
to come as the old ones begin to get dry. By the end of the 
second week all the lesions are covered with a dry, brown crust. 
Pain is characteristic of zoster. It precedes the eruptive spots and 
is of a neuralgic character. 

The typical zoster occupies one side of the trunk, following 
the course of the spinal nerves. The pain between the ribs may 
resemble pleurisy, before the eruption appears. It may be at- 
tended with mild fever, and by some has been thought to be in- 
fectious. It usually disappears in from two to four weeks, but if 
in the neighborhood of the eyes they may suffer permanent 
damage. 



DISEASES OF THE SKIN. 645 

Treatment. — Give tonics. Quinine is good. The following 
powder may be applied to the parts: 

Zinc oxide four drams 

Starch four drams 

Pulverized camphor t one ounce 

The following ointment is better to relieve pain : 

Zinc oxide four drams 

Opium one dram 

Lard or vaseline one ounce 

MILIARIA RUBRA. 
(Prickly Heat.) 

Miliaria rubra is an affection of the sweat glands, occurring in 
the heated term of summer. In children it is known as red gum. 
The eruption makes its appearance after unusual exertion or a 
hearty meal. In children it is a result of too much clothing or 
overfeeding. Any portion of the surface of the body is liable to 
be attacked. An examination of the affected parts will show them 
to be studded with countless minute vesicles from the size of the 
point of a pin to that of a pinhead, accompanied by intense itch- 
ing. The vesicles are always discreet, that is they do not run into 
one another, and do not rupture spontaneously as in eczema. 
There is never any general discharge. The general health of the 
patient is not affected by this disorder. 

While the rash is out, a glass of wine or a cup of tea brings on 
a sudden and violent attack of itching. The main changes affect 
the epidermis. Scattered through the reticular layer are oval or 
circular cyst-like spaces — sections of dilated sweat ducts, the con- 
tents of which may be wholly fluid, or contain cellular elements in 
considerable numbers. Some have tried to explain this disorder 
on the theory that by absorbing sweat the cells of the horny layer 
of the skin are made to swell and so press upon the mouths of 
the sweat ducts as to tightly close them at a time when perspira- 
tion has just ceased, and that any further secretion of sweat, while 
this condition lasts, must result in accumulations of liquid in the 
obstructed ducts and, by their dilatation, cause the tingling pain 
characteristic of prickly heat ; also that during this period of ob- 
struction anything which causes sweating brings on the attack. 

The disease bears a close resemblance to eczema, but in the 



646 DISEASES OF THE SKIN. 

latter disease the skin over the whole patch is affected uniformly, 
while in prickly heat the eruption is in patches and the skin is not 
uniformly red over the whole surface. Eczema is persistent; but 
prickly heat is only temporary, is a rash and occurs only in hot 
weather. 

Treatment. — The bowels should be kept free and regular, 
and the patient must restrain himself to a mild diet. Violent ex- 
ercise and heavy clothing should be avoided. A bath should be 
taken daily and the affected parts washed in a calamine lotion, or 
in a saturated solution of boric acid. Alcohol and water, or 
vinegar and water, will often give relief, which will be increased by 
following the wash with a cooling dusting powder composed of 
equal parts of starch, boric acid, talc and zinc oxide, all pulver- 
ized. The patient should also take saline remedies to stimulate 
the kidneys. The acetate and nitrate of potash, an equal part of 
each, form a good combination for this purpose, and should be 
taken in three-grain doses three times a day. 

VERRUCA. 

(Warts.) 

Warts are morbid growths, varying much in size, shape and 
character. 

They are found upon people of all ages, occur chiefly from 
contagion, and are composed of a prolongation of connective tis- 
sue, which contains a blood vessel and is covered by thickened 
skin. 

The common wart, verruca vulgaris, is generally found upon 
the hands, feet, ears and face, but may be found upon any part 
of the body. This form is most frequent in children. It may occur 
singly, or the fingers may be covered with them. They are from 
pinhead to pea size, and are hard, conical elevations with a flat- 
tened top and composed of the horny tissue of the skin. Their 
surface is either smooth or rough and may be made up of closely 
crowded projections. At first they are of the same color as the 
skin, but become darker with time and exposure. As a rule these 
warts appear slowly, but they may come on at once in considerable 
numbers. They may remain a long time, usually months or years, 
but in many cases disappear of their own accord, or from the action 
of some irritating drug. 

There is a form of warts called verruca plana, so named be- 



DISEASES OF THE SKIN. 647 

cause they resemble lichen planus. They are smaller than com- 
mon warts, and occur in greater numbers. They are found not 
only upon the hands, but upon the cheeks and other parts of the 
face. They are caused by elongations of the papillae, and hyper- 
trophy of all the layers of the skin. 

Another variety, verruca senilis, is met principally upon those 
of middle life to old age, and is more common in men than in 
women. It is favored by the gradual degeneration of the skin tis- 
sues in old people, by all irritating agencies, and by uncleanliness. 
It is found upon the back, arms, face, neck and trunk; is raised 
above the surface of the skin ; is round or irregular in shape ; and 
may be of the same color as the skin, or of a greenish yellow, 
brown or black. It may cause much annoyance by itching, and 
often makes a rapid growth and ends in skin cancer, for which 
reason it should be removed if any signs of increased growth ap- 
pear. From the fact that this wart is often of a fatty consistency, 
it has sometimes been classed as a seborrhea. 

Verruca filiformis is a form found upon the eyelids and chest 
ill people who ha^e attained adult age. In these warts the papillae 
do not seem to be involved, as the projection is made up of con- 
nective tissue from the lower layers of the skin. They usually oc- 
cur singly, and through the wart is a blood vessel. 

Verruca perstans is a persistent wart which remains un- 
changed. 

Verruca acuminata is a venereal wart. It is a soft, moist, 
papilla form growth upon the smooth skin. They are the most 
common in the sulcus and upon the penis, labia and perineum. 

Treatment. — Upon common warts, such as are seen upon chil- 
dren, nitric acid, glacial acetic acid, and acid nitrate of mercury 
may be used with good, effect. Any of these acids should be ap- 
plied with the point of a small stick, the surrounding skin being 
protected by a layer of collodion or some other film painted on 
for that purpose. Salicylic acid is one of the best remedies, as it 
softens the horny layer without causing irritation. It should be 
used in the proportion of one dram of the acid to one ounce of 
collodion, and be applied with a camelshair pencil twice daily for 
three days, then the wart should be carefully soaked in warm 
water and rubbed with pumice stone or sand soap. 

The acuminate form may be removed by keeping them dry 
and clean. The salicylic acid preparation may also be used, and, 



648 DISEASES OF THE SKIN. 

in very obstinate cases, glacial acetic acid, but this remedy should 
be used in very small quantity and carefully. 

Filiform warts should be clipped off. Senile warts should 
be thoroughly scraped, and their bases touched with nitrate of 
silver, or other caustic. Salicylic acid may be used, as for the other 
forms. Electro-cautery may also be used, but electrolysis is better. 

Sulphate of magnesia, given internally in small doses for a 
considerable time, is said to remove common warts, but experi- 
ence does not sustain the expectations of those who rely upon its 
efficiency. Better use external remedies only. 

ECZEMA. 
(Tetter. Salt Rheum.) 

Eczema means to boil out, and is the name applied to a 
certain acute, subacute or chronic inflammatory disease of the 
skin, characterized at first by erythema, papules, vesicles, or pus- 
tules, or a combination of these lesions, with a variable amount 
of infiltration and thickening of the skin, terminating either in dis- 
charge, the formation of crusts, in absorption, or in scaling, and 
accompanied by more or less intense itching. 

The disease is classified in several varieties, which are known 
by the kind of lesions present, or, in cases where there are more 
than one kind of lesions, by the principal kind. The principal 
varieties are as follows : 

i. Erythematous Eczema, beginning with an irregular out- 
line or hyperemic spot and more or less itching or burning. It 
may be limited to a certain region of the body, or be more or less 
generally spread over the surface. When fully developed the 
skin is harsh and dry, thickened and infiltrated and, usually, 
slightly scaly, with a tendency to oozing patches. Scratch marks 
may usually be seen scattered over the affected surface. It is 
most common upon the face, but is frequently found upon other 
parts. It is very likely to become chronic, in which case it is 
called eczema squamosum. 

2. Eczema Papillosum is characterized by numbers of dis- 
tinct, closely crowded, reddish, pinhead size, sharp or rounded 
papules (pimples), and was formerly known as lichen simplex. 
Vesicles and vesico-papules are often intermingled. It is most 
common upon the extremities. There is intense itching, and the 
patient can hardly refrain from scratching. The lesions tend 



DISEASES OF THE SKIN. 649 

sooner or later to disappear, but are usually replaced by others. 
The disease persists for weeks or months. In places where it is 
closely crowded a solid, thickened, scaly covering of eruption may 
result in eczema squamosum. 

3. Eczema vesiculosum, or the vesicular form, appears on 
one or several regions as diffused, inflammatory, reddened patches 
with closely crowded pinpoint to pinhead size vesicles, which 
tend to run together and form a solid sheet of eruption. The 
vesicles soon mature and burst, the discharge drying to a large 
honey-comb-like crust. The oozing is more or less continuous. 
The crusts may be cast off, to be followed quickly by another crop 
of vesicles. This form of the disease is usually chronic. In in- 
fants it is called milk crusts. 

4. Eczema pustulosum has its site upon the face and scalp, 
especially in the young and those who are ill-nourished. There 
is a marked tendency to a crusting of the lesions, the dis- 
charge drying in thick, brownish, yellowish or greenish crusts. 
In this form of eruption there are germs which cause pus forma- 
tions. 

5. Eczema fissam is a form in which a tendency to fissuring 
or cracking of the skin is an important symptom. This tendency 
to cracking varies considerably, according to the state of the 
weather, often disappearing in summer to return in winter. The 
disease is very common upon the hands and fingers, in which loca- 
tion it is known as chapped hands. 

6. Eczema seborrkoicum is an inflammation resembling 
both eczema and seborrhea. It is probably caused by a parasitic 
germ. This form occurs in sharply defined, rounded or irregular 
patches, and partakes of the nature of seborrhea, psoriasis and 
eczema, but most especially of seborrhea. There is not often any 
fever with it. The eczematous eruption or patches merge gradu- 
ally and imperceptibly into the surrounding healthy skin. The 
disease is worse in cold, windy weather, and may be due to con- 
stitutional or local causes or to both. The constitutional causes 
are gout, rheumatism, indigestion, general debility, nervous ex- 
haustion, cutting teeth and scrofula ; and the local causes are heat 
and cold, sharp, biting winds, excessive use of water, strong soaps, 
chemical irritants and scratching. 

7. Eczema mibrum is characterized by a red, raw-looking, 
weeping or oozing surface, attended by more or less inflammatory 



650 DISEASES OF THE SKIN. 

thickening, infiltration and swelling, the exudation consisting of 
serum, sometimes bloody, which dries into thick, yellowish, or 
reddish brown crusts. It is an important form, developing from the 
vesicular, pustular or other primary form. It is chronic, and varies 
in intensity from time to time. 

In appearance eczema resembles psoriasis, seborrhea, sycosis, 
itch and ring-worm. But psoriasis occurs in variously sized, 
rounded or sharply defined patches, usually scattered irregularly 
over the general surface of the body, with an especial fondness 
for the elbows and knees. These patches are covered over with 
whitish silvery scales, and are always dry, and the itching is usu- 
ally slight. Eczema on the contrary is often localized and appears 
as diffused patches, merging imperceptibly into the sound skin, 
and there is itching, accompanied by more or less oozing. 

The difference in the symptoms of seborrhea and eczema is 
that seborrhea of the scalp is commonly over the whole region, 
and is free from inflammation, the scales are of a greasy character, 
and the itching is slight; but in eczema of the scalp the parts are 
seldom entirely covered, inflammatory symptoms are usually 
prominent, the scales are dry, there is generally severe itching, 
and, at times, the serous or gummy oozing characteristic of this 
disease. 

Itch differs from eczema in its distribution, and by the bur- 
rows and the absence of all tendency to patch formation; then, 
too, itch is contagious and eczema is not. 

Sycosis differs from eczema in these respects : Sycosis is 
limited to the hair region of the face, is distinctly a follicular in- 
flammation, and is rarely very itchy, while eczema is diffused, in- 
volving other parts of the face, and is so itchy as to make itching 
its most prominent symptom. It also appears upon the lips, 
scrotum and legs. When accompanied by a swollen condition of 
the veins, a cure is effected only by a long and persistent course 
of treatment. 

Eczema of the scrotum appears as a papular eruption, but is 
not a usual form of eczema. It gives the scrotum a raw appear- 
ance, as though the skin had been scraped off, with a sticky dis- 
charge. 

In eczema of the arms the skin is cracked. Eczema is cura- 
able and does not leave scars, but its duration is indefinite. The 
chronic form may continue for years. 



DISEASES OF THE SKIN. 651 

Treatment. — Fresh air, exercise, regular habits, a plain, nutri- 
tious diet, abstention from pork, salted meats, acid fruits, pastry, 
sauces, pickles, condiments; excess of coffee and tea, beer, wine 
and other stimulants are forbidden. Soap and water is to be 
avoided as much as possible in the acute forms, but in the chronic 
and sluggish forms it may have a medicinal value. For chapped 
hands wash in a thin mush of wheat bran and water, prepared a 
few hours before using, rub them over the fire until thoroughly 
dry and draw on kid or thin leather gloves before retiring at 
night. In the acute stage black wash and oxide of zinc ointment 
may be used conjointly, the wash being thoroughly dabbed on 
and allowed to dry, then the parts gently smeared with the oint- 
ment. 



Black Wash. 

Calomel i ]/ 2 drams 

Mucilage tragacanth i ounce 

Lime water 8 ounces 



Oxide of Zinc Ointment. 

Oxide of Zinc ij4, drams 

Rose water y z ounce 

Vaseline ointment V> ounce 



Fowler's solution 2 drams 1 Or use: Potas. iodide 3 drams 

Bitter wine of iron 4 ounces I Distilled water 4 ounces 

Mix 30 drops in water and take three times a day, after meals. 

For Eczema of the Scalp. 



Salicylic acid 20 grains 

Zinc oxide 2 drams 

Vaseline 1 ounce 



Or, Boric acid 2 drams 

Vaseline 1 ounce 

Mix well and rub on the head. 



For Vesicular Eczema. [ Or, Pulv. zinc oxide 1 dram 

Zinc oxide 1 ounce | Rose ointment 4 drams 

Pulv. starch 4 ounces I Vaseline 4 drams 

Mix and use on the affected parts. To be rubbed on the eruption. 

For Eczema of the Nipple. To Relieve Itching. 

Acetate of lead 1 dram | Subnitrate of bismuth 1 dram 

Glycerin .... 1 ounce Rose ointment 1 ounce 

To be rubbed on nipple after nursing. | To be used on affected parts. 

DERMATITIS. 
(Inflammation of the Skin.) 

Dermatitis, or inflammation of the skin, is a term employed 
to designate those cases of skin disturbances, acute in character, 
which are due to the action of irritants, such as the various animal 
parasites, and to scratching, resulting in an inflammatory thicken- 
ing of the skin. 

The inflammation varies from a slight erythema to intense af- 
fections as seen in burns, scalds and frost bites. 

Treatment. — Apply common baking soda (not baking pow- 
der) as a powder to the affected parts. 



652 DISEASES OF THE SKIN. 

Other soothing solutions, such as sugar of lead, may be em- 
ployed. In frost bites immediately after exposure the parts should 
be brought back to normal temperature by rubbing with snow or 
by dipping into cold water, after which oil of turpentine may be 
applied. Balsam of Peru is good, so is carbolic ointment. The 
following ichthyol ointment is excellent : 

Ichthyol three drams 

Subnitrate bismuth two drams 

Vaseline one and one-half ounces 

Two ounces of common baking soda dissolved in a quart of 
hot water makes a good lotion for inflammation of the skin. 

DERMATITIS MEDICAMENTOSA. 
(Drug Eruptions.) 

Under this head is included all eruptions due to ingestion or 
absorption of drugs. Sometimes one dose will have such an effect ; 
commonly, however, an eruption results only after several days 
or weeks of continued administration. It is produced by the 
elimination of the drug through cutaneous structures, though it 
may sometimes be caused by the action of the drug upon the 
nervous system. It may be erythematous, papular, urticarial, vesi- 
cular, pustular, or bullous and, if the administration be continued, 
even gangrenous. 

Such drugs as antipyrin, arsenic, atropia (or belladonna), 
bromides, chloral, copaiba, cubebs, digitalis, iodides, mercury, 
opium, morphia, salicylic acid and turpentine produce erythema- 
tous and papular eruptions. Itching is usually present and a mod- 
erate scaling (desquamation) may follow. Arsenic may produce 
erythema and erythemato-papular eruptions. 

Atropia may produce erythematous and scarletinoid erup- 
tions. The bromides produce pustules, boils and carbuncles. 
Chloral hydrate may cause scarletinoid and urticaria, and some- 
times purpuria. Copaiba produces urticaria, erythematous, papular 
and scarletinoid eruptions. Cubebs cause erythematous and small 
papular eruptions. Digitalis causes scarletinoid and papular erup- 
tions. Iodide of potassium, pustular, papular, vesicular, bullous, 
tuberous, purpuric and hemorrhagic eruptions. Mercury, erythe- 
matous and erysipelatous eruptions. Iodide of potassium and 
potassium bitartrate, given together, are thought to have a. pre- 
ventive influence in the iodide eruptions. 



DISEASES OF THE SKEW 653 

ERYTHEMA SIMPLEX. 

Erythema simplex is divided into two forms ; the idiopathic 
and the symptomatic. 

The idiopathic form is that which arises independently of any 
other affection. The symptomatic form is that which is due to 
some constitutional disturbance. 

Erythema simplex is a hyperemic disorder characterized by 
redness, occurring in the form of variously formed and shaped, 
diffused or circumscribed, non-elevated patches. We include in 
the first class erythemas due to external causes, such as cold and 
heat, the action of the sun (as sunburn), injuries to the skin, chemi- 
cal poisons and chemical irritants. 

We include in the second class the erythemas due to disor- 
ders of the digestive tract and the ingestion of certain drugs. The 
idiopathic rashes are usually limited to certain localities of the 
skin, while the symptomatic erythemas are more or less general. 

Treatment. — In the idiopathic form the removal of the causes 
is all that is needed, the erythema subsiding within itself in a short 
time, but if thought best some of the dusting powders may be 
used, or mild, astringent, cooling lotions, such as are used in 
acute eczemas. (See page 651.) 

In the symptomatic forms some laxative is needed to remove 
the irritating substance from the intestinal canal. Epsom salts is 
good for this purpose. An adult should take a tablespoonful every 
four hours until the bowels move freely. For a child reduce the 
dose. 

Also use dusting powders and lotions the same as in the 
idiopathic forms. 

ERYTHEMA INTERTRIGO. 
(Chafing.) 

This occurs on the parts where the natural folds of the skin 
come in contact, and is characterized by redness, to which may 
be added an abraded surface, and maceration of the epidermis. 
There is a feeling of soreness. The perspiration and moisture of 
the parts give rise to maceration of the epidermis, and a mucoid 
discharge and inflammation may follow as results. The affection 
may pass away in a few days or last for weeks. The cause is usu- 
ally local and the trouble is chiefly found in the region of the but- 
tocks and genitals of children and fat persons. It is often a result 
of uncleanliness. 



654 ' DISEASES OF THE SKIN. 

Treatment. — The folds are to be kept apart by lint or absorb- 
ent cotton, and dusting powders or cooling and astringent lotiorts 
applied. One part of linseed oil to two of alcohol, applied after 
thoroughly washing with cold water, will afford relief. 

ERYTHEMA MULTIFORMA. 
(Blush.) 

This is an acute inflammatory disease, characterized by red- 
dish, more or less variegated macules, papules and tubercules, oc- 
curring as separate lesions, or in patches of various size and shape. 
The eruption is usually found upon the extremities, upon the 
backs of the hands and forearms, and on the knees, elbows and 
legs. The disease comes without any warning or symptoms of 
malaise, gastric irritation or rheumatic pains, the eruption sud- 
denly making its appearance, and assuming an erythematous, pap- 
ular, tubercular or mixed character; but, as a rule, one type of 
lesion predominates. The lesions tend to increase in size and in- 
tensity, and may remain several days, then gradually fade away 
but, during this time, new lesions may make their appearance. 
In color they are pink, red and violaceous. Slight itching may or 
may not be present. 

The papular eruption is usually found upon the backs of the 
hands and forearms and often upon the hands and feet. The 
causes are obscure. It is most frequent in the spring and autumn 
months, and is a mild inflammatory disease, often called blush, 
somewhat similar to urticaria. The diagnostic points are the uni- 
formity of the eruption, the size of the papules, the limitation to 
certain parts and the absence of itching. It resembles urticaria at 
times, but the lesions of the latter disease are short-lived, disap- 
pearing and reappearing in the most capricious manner, are com- 
monly seated upon the trunk and are exceedingly itchy. The 
outcome in blush is always favorable. 

Treatment. — Quinine and saline laxatives, and local cool- 
ing lotions of equal parts of alcohol and vinegar. 

PEDICULOSIS. 

(Lousiness.) 

Three forms of lice are found upon the human skin, which 
are named according to their habitats — the head, the body and the 
pubis. They secure their nourishment by abstracting blood, thus 



DISEASES OF THE SKIN. 655 

producing an irritation of the skin which leads to scratching and 
inflammation. These parasites always remain upon the surface, 
and deposit their eggs upon the hair or clothing. The presence 
of lice upon the head is very common among children, especially 
the poorer classes. 

Head Lice. — Associated with the eruption produced by the 
head louse, through the irritation of scratching, an eczema may be 
established behind the ears and on the neck. The parasite is the 
primary cause of the whole trouble. It is of a whitish gray color 
and easily recognizable. It moves slowly and holds on to the hair. 
It has six legs attached to the front part of its body, ending in pre- 
hensile hooks. The female is larger than the male and lays a 
large number of eggs, which hatch in about three days. 

It is stated that one can lay about fifty eggs in six days and 
would, were none destroyed, increase to 5,000 in six weeks. The 
eggs are deposited on the hairs, to which they are firmly attached 
by some secretion from the insect. 

Treatment. — The best remedy is to saturate the head with 
coal oil. 

It should be done three times within twenty-four hours and 
a cap each time be placed over the head, and worn half an hour, 
and the head then shampooed. If the treatment is not a success 
it should be repeated from time to time until there are no longer 
any parasites or their eggs. 

Many other remedies are recommended, but none of them are 
equal to the coal oil. Cutting the hair is unnecessary. 

The Indians of New Mexico destroy this parasite with a cap 
made of clay. After the clay cap has been worn a certain length 
of time the parasites are all found dead and the hair is improved 
in general appearance and nutrition. The arsenic in the clay 
causes the death of the parasite. 

Body Lice. — Unlike the head louse this insect is found more 
frequently among adults than among children, and among men 
than women. It is found especially among tramps. Its favorite 
places are on the shoulders and hips and around the neck and 
waistbands. When we find an eruption from scratching in these 
two regions we can suspect the presence of body lice. Always ex- 
amine the seams of the clothing for the diagnosis of this form of 
insect is not easy, as it hides in the seams of the under clothing, 
where it deposits its eggs. This insect has a long proboscis which 



656 ' DISEASES OF THE SKIN. 

it projects into a sweat gland from which it draws its nourishment. 
After the proboscis is withdrawn a drop of blood is found in the 
opening, there is more or less irritation and scratching and an 
eruption appears in the form of wheals, or a mosquito bite. 

Treatment. — Take a bath, then thoroughly boil the under 
clothes and iron them, especially in the seams, with a very hot 
iron. As the habitat of the animal is within the clothes they need 
the closest scrutiny. This kind of lice always yields to cleanli- 
ness 

Crabs. — These animals may be found not only on the pubis, 
but in the axilla, on the hair of the abdomen and chest, and some- 
times upon the whiskers, eyebrows and eyelashes. Sometimes the 
hair of the legs is covered with them. The crab clings closely to 
the hair at the surface of the skin; resembles wheat bran in shape 
and seems to assume the color of the skin, which it inhabits. It is 
found mostly with adults and is chiefly spread through sexual com- 
merce and clothing and bedding. On attempting to remove the 
parasite it is found clinging firmly with its claws at the base of the 
hair with its head within the follicle. Its eggs seem to be cemented 
to the hair, close to the skin. Itching, with papules and inflam- 
mation in the pubic regions, should always lead to the suspicion 
of the presence of crabs. 

The diagnosis is between that of itch, eczema and pruritis. 

Treatment. — 

Beta naphthol one-half dram 

Lard or vaseline one ounce 

Whatever the treatment, the parts should afterward be well 
bathed, and some anti-parasitic must be used to kill the insect and 
its nits. 

Tobacco juice and fish berries are often used, but neither is as 
effectual as bichloride of mercury, from three to five grains to an 
ounce of water, or ten grains of the bichloride to one ounce of 

lard. 

SCABIES. 
(Itch.) 

Sarcoptes or acarus scabies is a small animal parasite that 
gets its living from the human skin. It is a white insect, so small 
as to be hardly visible to the naked eye, has eight legs and bur- 
rows in the skin. It frequents the thinnest and most tender parts 



DISEASES OF THE SKIN. 657 

of the skin, and is usually first observed between the fingers. 
From the hands it is communicated to the genital organs. In 
females the insect is especially found around the nipple and over 
the hips. The diagnosis is very easy from the burrows which the 
insect makes. Only the female is found in these burrows. She 
enters the skin for the purpose of nutrition and depositing eggs. 

The burrows are in lines, sometimes straight and sometimes 
curved. The eggs are deposited along these burrows, which vary 
from an eighth to a half inch in length and which, under a small 
magnifying glass, appear like finely dotted lines. The female is 
found at the end of the burrows and dies there unless scratched 
out. The young follow the same course as the old ones, the irrita- 
tion produced causes inflammation, and there are found papules, 
vesicles and pustules. 

There are more than one variety of scabies, and some of them 
are found upon sheep, horses, cattle, pigs, dogs and cats. The 
same remedies as used on the human body will prove effectual on 
all lower animals, if properly applied. 

Treatment. — The patient should first be soaked all over in 
warm water, and soap should be rubbed freely and thoroughly into 
his skin for half an hour, or until the skin is well softened, after 
which the following ointment should be well rubbed in: 

Sulphur precipitate one-half dram 

Balsam of Peru one-half dram 

Lard or vaseline two ounces 

Or use : Beta naphthol two drams 

Lard or vaseline two ounces 

Each of these should be thoroughly mixed. Bichloride of 
mercury should not be used, since, by spreading it over a large 
surface, its absorption might poison the patient. 

After the above treatment the patient should be dressed in 
clean clothing and the infected clothes carefully cleansed and 
ironed with a hot iron or kept two hours in an oven in a heat of 
300 to 350 degrees. As some of the eggs may not be reached by 
the first treatment, repetition may be necessary, but over-treatment 
is not desirable, as it would keep up the irritation begun by the 
parasite. 

There is a mystery in the vitality of lower animal life. The 
lower forms are almost deathless, and the very lowest, if left to 

42 



658 DISEASES OF THE SKIN. 

themselves, are immortal. The single cell does not die, but divides 
into two cells which again divide and subdivide to infinity. Death 
is a result of complex or higher organization, and the higher the 
organism the more easily it is destroyed. This fact should always 
be kept in view in using remedies. It is often easier to kill the pa- 
tient with germicides than to kill the germs. 

CIMEX LECTULARIUS. 
(Bedbug.) 

The real habitat of this animal is not merely the bed and bed- 
ding, but cracks in the walls, floors, chairs, cushions, sofas and 
seats in public conveyances. The bite produces itching, conse- 
quently scratching, then an eruption which is ordinarily attributed 
to bad blood. When the bug punctures the skin it injects an irri- 
tating fluid, which causes an increased amount of blood in that 
locality. This puncture produces a stinging sensation and an erup- 
tion in the form of wheals, which is liable to be mistaken for urti- 
caria. That from bedbugs is usually upon the back, while that 
from urticaria is upon the front portions of the body. When the 
pests are removed the inflammation in the skin usually disappears. 
This inflammation is best treated by a saturated solution of 
bicarbonate of soda, ammonia water or spirits of camphor. To 
rid the home of these pests all cracks in the bedsteads, floors, walls 
and furniture should be liberally treated with boiling water or a 
strong solution of bichloride of mercury. For cushions, sofas, 
etc., gasoline or kerosene should be freely used. 



CHAPTER III. 

TINEA TRICHOPHYTINA. 
(Ringworm.) 

The two words tinea (gnawing) and trichophytina (hair- 
plants) are used to designate a genus of very tiny plants, known to 
scientists as microscopic fungi, which often effect an entrance into 
the human skin and there, in and beneath the epidermis and in 
the follicles, live as parasites, rapidly multiply, poison the tissues 
and cause inflammation, resulting in the diseases of the skin 
known as follows : 

Tinea trichophytina capitis, or ringworm of the scalp, scald- 
head. 

Tinea trichophytina circinata, or ringworm of the body, trunk 
and limbs. 

Tinea trichophytina sycosis, or ringworm of the face, barber's 
itch. 

Tinea trichophytina cruris, or ringworm of the crotch and 
axilla. 

Tinea trichophytina unguium, or ringworm of the nails. 

There is a difference of opinion as to these diseases. Some in- 
vestigators think that they are all really one and the same disease 
caused by identically the same fungus, the characteristic symp- 
toms varying in each case according to the part of the body at- 
tacked; that the microscope discloses no difference in the germs, 
either in shape or arrangement, and that experiments have proven 
that all forms of the disease may be produced from cultures de- 
rived from one germ. Others incline to the opinion that there 
are many varieties of these little plants, just as there are different 
kinds of oaks, that each has its preference for certain tissues or 
locations on the body, and that each produces a poison that causes 
its own peculiar type of ringworm. It is not of much importance 
to know which view is correct, for the fungi in all the forms are' 
destroyed by essentially the same germicides. 

659 



660 DISEASES OF THE SKIN. 

RINGWORM OF THE SCALP. SCALD-HEAD. 

As already indicated this disease is caused by a tricophyton 
finding a lodging place in the scalp and vegetating there. It is 
most often found among children, and begins as a small pale-red 
or gray spot, slightly elevated, and covered with fine bran-like 
scales. As fast as the follicles become much involved their hairs 
get dry and brittle, and either break off near the skin or fall out. 
In mild cases the hair will grow again, but in the deep seated forms, 
such as usually occur in scrofulous and other ill-conditioned pa- 
tients, there is likely to be a pustular eruption, thick yellow crusts, 
and superficial abscesses of the scalp, resulting in the destruction 
of the follicles so that in the affected patches the hair is perma- 
nently destroyed. 

Unless arrested the disease may continue to slowly spread 
until it extends over the entire scalp and down upon the neck, and, 
although there is not much pain aside from the discomfort from 
itching, the appearance of the scalp becomes repulsive in the ex- 
treme. Sometimes, though not often, it is difficult to distinguish 
this disease, in its earlier stages, from several other affections of 
the scalp, but by moistening a few of the affected hairs, or a small 
piece of the outer skin, in liquor of potassium, then examining them 
with a lens, magnifying from 250 to 300 diameters, the fungi and 
their spores will readily be detected if it be a case of trichophy- 
tina. The chloroform test is also quite positive, and many rely 
upon it instead of resorting to the microscope. It consists of dip- 
ping affected hairs in chloroform. If they turn white when thus 
treated, it can be depended upon that the trouble is ringworm of 
the scalp. 

Treatment. — There are two principles to be employed in the 
treatment of this disease: 

1. The application to the scalp of some germicide which 
will destroy the parasites without doing much harm to the skin 
itself. Mercury, iodine, sulphur, and many other substances will 
destroy the fungi when brought in contact with them, but the 
problem is to get the remedy to so penetrate as to reach the 
microbes down within the epidermis and hair follicles. 

2. The exclusion of air, for this fungus is known to require 
oxygen. To secure both of these ends — penetration of the germi- 
cide into the epidermis and the depths of the follicles, though at 
the same time filled with their diseased hairs, and smothering the 



DISEASES OF THE SKIN. 661 

microbes by the exclusion of air — various means are used, all of 
which require care. 

First wash the scalp with tincture of green soap (saponis viri- 
dis two ounces to one ounce of alcohol), made into a lather 
with warm, soft water, dry the scalp with hot towels immediately 
after, then thoroughly anoint with the following ointment : 

Carbolic acid five to twenty grains 

Red oxide of mercury ointment one to two drams 

Nitrate of mercury ointment one to two drams 

Rose water one ounce 

This treatment should be applied every morning, and as heat 
and moisture promote the growth of the fungi, the head should be 
kept cool and dry, and washed only when preparing the scalp for 
the anointing. 

Single patches may sometimes be destroyed by tincture of 
iodine, well and frequently rubbed into the spots, and its drying 
and hardening may be prevented by the addition of a little glycerin, 
about a dram to the ounce. The principal remedies which have 
been employed in solution are bichloride of mercury, salicylic acid 
and borax. From two to ten grains of the bichloride, dissolved m 
a half ounce each of water and alcohol, are very efficient in de- 
stroying the fungus, but there is difficulty in getting it to pene- 
trate deeply enough to reach the germs in the lower tissues, al- 
though there is some danger from absorption of the poison. It 
should never be used over a very large surface, especially if of a 
strength of five or more grains to the ounce of water or alcohol, 
and should there be increased tenderness in the parts to which it 
is applied, or a green diarrheal discharge from the bowels, the 
bichloride treatment must be discontinued immediately, for these 
symptoms indicate mercurial poisoning. 

Dr. Shoemaker, who has had large experience, says in his 
Diseases of the Skin, D. Appleton & Co. : "I usually begin by di- 
recting the diseased spots to be sponged every day or two with a 
weak alcoholic solution of thymol, borax, naphthol, or mercuric 
bichloride, and to be then thoroughly saturated with a fifty-per- 
cent solution of boro-glyceride. The latter solution cannot be 
recommended too highly. In the early stages of ringworm of the 
scalp I have obtained many rapid cures from its use alone. Borax 
is one of the most efficient antiseptic and antiparasitic agents. It 



662 DISEASES OF THE SKIN. 

also possesses mild astringent powers, and tends to allay the itch- 
ing and irritation of the disease. The glycerin has great penetrat- 
ing properties, and carries the parasiticide deep into the follicles. 
It also has great affinity for water, which it withdraws from the 
tissues, thus depriving the fungus of one of the elements most 
contributive to its existence. The boro-glyceride solution may be 
applied night and morning with a little sponge or mop, and should 
be well rubbed into the skin with the tips of the fingers. It is desti- 
tute of any poisonous or irritating qualities^ and acts as a prevent- 
ive of further contagion, as the parasite adheres to the glycerin and 
is not cast off to be wafted about in the air." 

Salicylic acid, either as a solution or in an ointment, is de- 
structive to the fungus and may be safely used. It is also valuable 
in collodion, ten to thirty grains of the acid to the ounce of collo- 
dion, painted over and around the spot, after shaving off the hair, 
but many are averse to shaving the hair, as likely to increase the 
itching without affording any substantial advantage. The follow- 
ing are formulae for the solution and ointment : 

Salicylic acid one to four drams 

Rectified spirits of wine one-half ounce 

Glycerin one ounce 

Distilled water two ounces 

Salicylic acid one to two drams 

Vaseline one ounce 

The following is an excellent remedy, but for reasons already 
given must be used sparingly and with care : 

Bichloride of mercury ten to twenty grains 

Green soap two ounces 

Rectified spirits of wine one ounce 

It must be remembered that this disease is not only con- 
tagious, but that it is sometimes disseminated by spores borne for 
some feet through the air. To prevent the latter danger the scalp 
should be kept anointed that spores and dried fungi may not es- 
cape into the air, and as a safeguard against contagion, the pa- 
tient should be isolated as far as practicable from other children, 
should sleep in a separate room, and should not touch the clothes, 
brushes, combs, wash-basins or towels of other persons (and all 
towels used upon him should be boiled to prevent them from be- 



DISEASES OF THE SKIN. 663 

coming mediums of contagion). The spores retain their vitality 
for many months, and special care must be taken against the in- 
fection getting into woolens of any kind, since such fabrics make 
the best hiding places for germs. After treating the patient, the 
nurse should, each time, thoroughly wash her hands with the 
tincture of green soap and water. If the green soap cannot be ob- 
tained, the old-fashioned soft soap is the best substitute. 

RINGWORM OF THE BODY, TRUNK AND LIMBS. 

Ringworm of the body varies greatly in form and appearance 
in the different cases, from a single small spot which may be easily 
checked, to an extensive eruption, covering much of the surface. 
The small red spot with which it begins cannot be distinguished 
at first from other lesions, but it soon becomes a little scaly, en- 
larges with considerable rapidity, and in from two days to a week 
may be a half-inch in diameter. As it increases m size there is a 
tendency to clear in the center, so that the inflamed portion as- 
sumes the form of a ring, leaving the skin at the center, however, 
not perfectly healthy, but of a yellowish hue and more or less 
scaly. As the diameter of this cleared place continues to increase, 
an affected spot may likewise appear in its center and follow a 
course similar to that of the first one, and, by several repetitions of 
the process, as many concentric rings be formed on the surface of 
the body. Itching may or may not be an accompaniment, but 
usually there is enough of it to cause discomfort, and sometimes 
is so excessive as to be quite painful. The affection is very much 
like the other forms of ringworm, and is a superficial inflammation 
of the skin wholly due to the development in its outer layers of 
some form of the trichophyton already described. Its gravity 
principally depends upon the physical condition of the patient. 
Sometimes it runs its course and disappears without any treatment, 
in other cases it may become chronic and remain a long time, even 
disappearing in summer only to reappear in winter. The cases 
contracted from lower animals are likely to be more severe and 
last longer than those taken from persons. 

Treatment. — Any application that will destroy the life of the 
parasite without causing much inflammation of the skin will be of 
service. The preparations of mercury, iodine, sulphur and a few 
other substances are the remedies most used. An ointment of the 
white precipitate, red oxide, or nitrate of mercury, one part of 



664 DISEASES OF THE SKIN. 

either to five parts by weight of lard, well mixed, with five drops 
of carbolic acid and a half-dram of sulphur added to each ounce 
of the mixture, is an excellent application if well rubbed in. Two 
drams of hyposulphite of soda in an ounce of water will often 
quickly destroy the parasite ; and from two to ten grains of bi- 
chloride of mercury to a half ounce each of water and alcohol, care 
being taken to apply it only to small areas, and to reduce the 
strength or discontinue the remedy in case of symptoms of poison- 
ing appearing, as described in the treatment for ringworm of the 
scalp. Ten to forty grains of chrysarobin to the ounce of lard is 
very effective, but the disagreeable stain it imparts to clothing is 
an objection. 

The patient finally gets well but the disease may be so ob- 
stinate as to require very faithful and persistent treatment, for 
until the last germs are killed there is likely to be a relapse. 
There should be frequent changes of clothing, and as soon as re- 
moved the soiled clothing should be boiled. 

RINGWORM OF THE FACE. BARBERS' ITCH. 

In its earlier stages this affection is confined to the outer 
layers of the skin. It begins as one or more red points, each of 
which gradually enlarges and becomes an inflamed area, as in 
ringworm of the body, which it resembles more than it does ring- 
worm of the scalp, both in the greater severity of the inflammation 
and in the rapidity with which it spreads over considerable sur- 
faces. The beard does not show the same tendency to break that 
is seen in the hair in ringworm of the scalp, but, as the disease 
progresses and the fungi penetrate the deep follicles of the beard, 
their hairs die and become so loose as to be easily rubbed out with 
a towel, or removed with forceps without pain to the patient, and 
this peculiarity is a very strong diagnostic feature of the disease. 
At this stage the inflammation has become deeply seated, the af- 
fected places painful, swollen and puffed, giving a boggy sensa- 
tion to the touch, and an impression that there may be pus within 
that should be let out with the lance. The nodules, or inflamed 
places, may run together and form one or more large swellings or 
lumps, the surface of which may be covered with a yellowish crust. 
As to severity, the disease varies greatly in different cases, but it is 
likely to be very persistent and hard to get rid of, for until the last 
germs are destroyed they may multiply and cause a return of the 
trouble. It often takes months, sometimes years, to effect a cure. 



DISEASES OF THE SKIN. 665 

Treatment. — Each morning wash the hands, face, neck and 
lastly the affected parts carefully and very thoroughly with suds 
of soft water and tincture of green soap, dry with a clean, warm 
towel, with forceps carefully remove all loose hairs, and with cot- 
ton or a soft cloth immediately apply to the swollen places the 
bichloride solution as recommended for ringworm of the body, 
then cover with a little absorbent cotton, binding it on loosely. It 
is well to begin with a two-grain solution, and in case the disease 
seems stubborn, increase its strength up to ten grains to the ounce, 
always remembering that bichloride solutions are deadly poisons 
and are safely applied to only small areas. Every evening at 
bedtime the parts should be washed in a saturated solution of 
boric acid, dried and anointed freely with the following : 

Carbolic acid five to ten grains 

Tannic acid, pulverized one-half dram 

Glycerite of tannin one-half dram 

Sulphur precip one-half to one dram 

Rose ointment one ounce 

The boro-glyceride treatment recommended for ringworm of 
the scalp is excellent also for this form of trichophytina. 

Do not lance. Be very thorough and regular in the treat- 
ment. Unless the patient is in a bad constitutional condition, he 
will require no internal remedies. The same caution must be ob- 
served in regard to the contagion in this as in other forms of ring- 
worm, for it is claimed that the fungus of barber's itch will cause 
both ringworm of the scalp and ringworm of the body, and there 
is more danger of children contracting either of these two diseases 
from this source than there is of one man acquiring barber's itch 
from another. As a medium of the contagion it is thought that 
the shaving brush is much more dangerous than the razor. Like 
the other forms of ringworm, it is sometimes contracted from the 
lower animals. 

RINGWORM OF THE CROTCH AND AXILLA 

This is the same disease as ringworm of the body, differing 
from it in appearance and intensity only because of the greater 
warmth and moisture and perhaps thinner skin at the armpits, the 
fold between the buttocks, and the adjacent parts — conditions fa- 



DISEASES OF THE SKIN. 

voring the rapid growth and multiplication of the fungi. The in- 
flammation in this form is much greater than in the ringworms of 
the other locations, and the itching and suffering therefrom are 
sometimes very severe. 

Treatment. — The same treatment as that recommended for 
ringworm of the face will be found efficient here. The addition of 
thirty grains of salicylic acid to an ounce of the carbolic ointment, 
well mixed and applied morning and evening by thoroughly rub- 
bing it into the skin of the affected parts, will often cure, but, like 
the other ringworms, this form is also liable to be troublesome for 
a long time. Thorough and frequent disinfection of the clothing 
by boiling, and disinfection of the parts and their surroundings, 
by washing with the green soap tincture, then applying the bi- 
chloride solution to small surfaces, or, considerably diluted, to 
larger ones, will greatly assist in overcoming the parasite. 

RINGWORM OF THE NAILS. 

This is so rare as not to demand a separate consideration here. 
It must be treated by germicides very persistently, for the diffi- 
culty of reaching the fungi under the nails often results in their 
doing mischief a long time. Scratching to relieve the itching from 
other forms of ringworm is a fruitful cause of this aggravating 
trouble. As a precaution, the hands should be carefully washed 
with soap and water, and the nails well cleaned after treating any 
form of ringworm. 

CHILBLAINS. 

A chilblain is an inflammation of the skin and is characterized 
by redness, and intense itching and burning. It is found most 
often upon the heels and toes, but may occur upon the nose and 
ears. It is caused by exposure to cold. 

Treatment. — Soak the feet in water as hot as can be borne, 
then shower them in cold water, rub dry, and apply carbolic oint- 
ment, made by adding ten drops of carbolic acid to an ounce of 
melted lard or vaseline and stirring until cold. If the blains are 
ulcerated, wash well with warm water and castile soap, dry them 
and apply the ointment. Some prefer to wash the parts three 
times a day in the following lotion : Oil of turpentine, two ounces ; 
spirits of camphor, three drams. 

Bathing the feet in warm salt water every morning and even- 



DISEASES OF THE SKIN. 667 

ing is said to prevent chilblains. Wearing warm woolen stockings, 
by stimulating the circulation, affords an additional safeguard. 

CLAVUS. 

(Corn.) 

A clavus or corn is a small, flattened, deep-seated formation, 
usually upon the toes, but sometimes upon the soles or other parts 
of the feet. It appears like a callous and is a thickening and hard- 
ening of the scarf skin, caused by friction or pressure, and generally 
a result of tight or ill-fitting shoes. Soft corns are formed in the 
same way as hard corns, but are between the toes where the mois- 
ture of the foot keeps them from drying and hardening. 

Treatment. — Soak the feet fifteen minutes in hot water, then 
scrape away as much of the thickened tissue as can be removed 
without pain or bleeding, and paint the corn, but not the surround- 
ing skin, with the following : 

Salicylic acid thirty grains 

Extract Indian hemp ten grains 

Collodion six to twelve drams 

Repeat the painting morning and evening for three days, then 
soak the feet again in hot water and the entire corn, in most cases, 
can be easily removed, but care must be taken not to try to remove 
it too soon, or to make it bleed, as peeling down into the live 
flesh would make it very sore, hence proceed carefully, and if 
necessary paint again. Soft corns may require searing with a stick 
of nitrate of silver, or a little acetic acid. It is a severe resort, 
but in case its use is required, oil the surrounding parts to prevent 
the healthy skin from being burned, then apply the acid with a 
small stick, as a tooth-pick, after which cover the wound with 
soft cloth saturated in linseed oil and later remove the dead skin. 

Tincture of iodine, applied night and morning after carefully 
scraping away all dead tissue, is recommended. 

To prevent further friction and pressure wear a piece of felt 
or thick, soft leather, with a hole in the center, just over the corn. 
Remove the cause and corns will usually get well without treat- 
ment. They can be avoided by wearing shoes of soft, pliable 
leather, that properly fit the feet and by often bathing the feet and 
keeping the nails pared, and all dead skin and callouses removed. 



668 DISEASES OF THE SKIN. 

BUNIONS. 

Bunions are enlargements of the joints of the great toe, some- 
times of the little toe, caused by wearing too tapering, narrow or 
short shoes, the pressure and irritation causing the skin to swell 
and become very painful. 

Treatment. — Wear large, easy shoes, and, if the skin is not too 
much inflamed, apply an adhesive plaster to the bunion and wear 
it until there is no more trouble. If badly inflamed, apply a bread 
and milk or other soothing poultice until the inflammation is gone, 
then apply iodine ointment, fifteen grains to the ounce of lard, 
and rub it in thoroughly night and morning. 

Wear felt or leather plasters cut m the form of rings, as for 
corns, to protect the joint from pressure. Some advise bathing 
the part in biniodide of mercury, two grains to the ounce of water. 

ONYXIS. 

(Ingrowing Nails.) 

This very painful ailment usually occurs upon the great toe, 
and is caused by tight shoes or some injury to the toe that has 
distorted the matrix. 

Treatment. — Scrape the entire nail until as thin as it can be 
made without bleeding, soak the foot fifteen minutes in hot wa- 
ter, after which remove all dead skin and scrape the ingrowing 
edge, and crowd under it a pledget of cotton, wet the cotton with 
a few drops of oerchloride of iron night and morning until the 
over-reaching flesh has become so benumbed and deadened that 
after soaking in hot water it can be rubbed off. 

An old and good method, first used by Dr. Finch, is to take 
a small, thin piece of silver plate, bend one side to make an up- 
turned flange and crowd it under the ingrowing edge, after the 
nail has been well softened by poulticing twenty-four hours, then 
bend the plate over the end and side of the toe and hold it in place 
by adhesive plaster. In a few days the toe will be well. 

ONYCHIA. 

(Run-around.) 

This disease is most common in children and is due to an un- 
healthy condition of the system, or to some slight injury. It be- 
gins by inflammation in the matrix, and a small ulcer eats its 
way through the soft tissues about the nail and, if unchecked, may 



DISEASES OF THE SKIN. 669 

spread until the entire nail becomes involved, loosens and drops 
out. The bone may also become affected and enlarged. 

Treatment. — Apply hot linseed meal poultices. Wet the part 
each day in a strong solution of salt, alum or sulphate of zinc. If 
pus forms remove it and into the ulcer rub a little powdered salt 
or alum. Also take measures to improve the general health by 
diet and observance of hygienic laws. The use of a gentle tonic 
is recommended, such as ten to twenty drops of the syrup of the 
iodide of iron three times a day. 

WHITLOW OR FELON. 

A whitlow or felon is a very common form of inflammation 
of the fingers. It is usually situated in the subcutaneous tissues, 
or in the facias that bind the tendons and hold them in position ; 
or it may be in the cellular tissues that connect with the bone and 
the tough inelastic membrane, called the periosteum, enveloping 
the bone; but in the more intense varieties the disease is usually 
located within the periosteum itself. Again we And the inflam- 
mation in the tissues around the margin of the nail, but this form 
is generally mild and not likely to result in serious damage. 

The principal cause of a felon is some injury, often slight and 
unnoticed at the time, to the affected tissues when the blood has 
become impoverished, as from poor diet, bad air, dissipation, etc. 
It usually occurs on the inside of a finger, with sharp pain and 
swelling of the pulp, the former increasing in intensity and the lat- 
ter in size until frequently it extends quite around the finger, and 
often the entire hand becomes swollen, tense and hard. After the 
third or fourth day the pain assumes a throbbing character, and 
the patient can get neither rest nor sleep. There is but little fever, 
the temperature not rising more than one degree and the pulse 
remaining nearly normal. From the fifth to the sixth day pus 
forms which, if allowed to remain, is likely to burrow under the 
tight, fibrous bands surrounding the periosteum, and may result 
in its destruction and the death of the bone. 

Treatment. — Cleanse the part and soak it for a little while 
two or three days, then, until the fifth or sixth day, use ichthyol 
and vaseline in equal parts, to thoroughly soften the tissues, then 
lance, using care to make a large incision and to carry it down to 
the bone. This can usually be done as well from the side of the 
finger, and with less danger to the tendons than by cutting 



670 - DISEASES OF THE SKIN. 

through the pafmar surface. Do not postpone lancing longer than 
the sixth clay or it may be too late to save the joint. 

After the lancing and evacuation of pus, the cavity should be 
well cleansed every day with a solution of hydrogen peroxide, di- 
luted with twice its volume of distilled water. An ounce of castor 
oil with sixteen drops of carbolic acid also forms a good cleansing 
agent and may be used instead of the peroxide. 

Constitutional treatment consists of quinine and iron, also in 
general improvement in diet and the securing of more hygienic 
surroundings. In old people the urine should be tested for sugar, 
as this trouble is likely to be associated with some other depraved 
condition of the system. 

NEVUS PIGMENTOSA. 

(Mole.) 

Moles are dark, circumscribed spots upon the skin, sometimes 
smooth, sometimes rough, either flat or elevated, and of the size 
of a pinhead to a bean, or larger. They may be the seat of long, 
coarse hairs, are very common, are usually permanent and often 
cause much disfigurement of the face and neck. 

Treatment. — The best way is to remove them by electrolysis, 
as that is less likely to cause ugly scars than either the knife or 
caustics, both of which are often used. Any change in the appear- 
ance or growth of a mole should be followed by immediate re- 
moval, as melanotic cancers frequently develop from moles. The 
danger from this is greatest in persons in middle or later life. 

FURUNCLES. 
(Boils.) 

A furuncle, or boil, begins as an acute deep-seated, inflamma- 
tory, circumscribed, rounded or more or less accumulated, firm, 
painful formation usually terminating in the formation of a cen- 
tral core and its discharge by suppuration. Long before the ex- 
citing cause of boils was understood, they were known to be asso- 
ciated with a depraved condition of the general health, but they 
are now known to be due to either of two kinds of germs, of which 
one produces white, the other yellow pus. They are very common 
germs and are always liable to be upon the surface of the skin, but 
it is thought that they can pass through into the tissues only when 
the skin is in an unhealthy condition, as when the patient is suffer- 



DISEASES OF THE SKIN. 671 

ing from diabetes meiitus, anemia, blood poisoning, eczema or 
other skin disease, or after an attack of fever or some other wast- 
ing disease, or from overeating or under exercise, or when the skin 
has suffered external injury, as from scratching or chafing. It is 
probable that their entrance is chiefly made through diseased folli- 
cles. Boils usually appear singly at first, but may follow in crops, 
and sometimes reappear for weeks or months. 

Treatment. — If treated early enough, a boil can usually be 
aborted, stopped by applying to its center a drop of strong car- 
bolic acid with any small instrument, as a toothpick, once in five or 
six hours. If this fails to relieve, a five-per-cent solution of car- 
bolic acid should be injected with a hypodermic syringe into 
the apex of the boil, care being used to reach the core. Instead of 
this, a sharpened hardwood toothpick may be dipped in strong car- 
bolic acid, then quickly thrust to the center of the boil. If done 
early enough, either of these measures is likely to effect a cure, and 
the pain caused lasts but a short time. The use of the acid should 
be followed by a dressing of soft cloth, saturated in carbolized 
vaseline or boric acid solution. 

If the boil has been allowed to go on until it is too late to stop 
it, lance to the core as soon as pus is fully established, after which 
a boric acid solution, or better still, a solution of bichloride of mer- 
cury, from one to three grains to the ounce of water, should be ap- 
plied to prevent the formation of new boils ; after which the wound 
may be dressed with the carbolized vaseline. A boil should never 
be pinched or squeezed, and it should not be poulticed, for the 
heat of a poultice only favors the development of germs, and its 
softening the skin facilitates their penetration to the subdermic 
tissues, thus helping in the production of more boils. It is often 
because of such self-infection that successive crops of boils are due. 

The old idea that it was unsafe to "scatter a boil" lest it ap- 
pear elsewhere upon the patient or cause him serious illness, has 
been discarded. To abort a boil does not mean to scatter it, but 
to kill it by killing the bacteria producing it, before they have de- 
veloped in sufficient numbers to cause suppuration. That the pa- 
tient may almost immediately be troubled by other boils is not due 
to the same bacteria that caused the aborted boil, but, usually, to 
a continuance of the same unhealthy condition of the skin, permit- 
ting the entrance of other pus germs from the outside. Neither is 
it true that "every boil is worth five dollars," for a boil depletes 
and contaminates the blood instead of purifying it. 



672 DISEASES OF THE SKIN. 

CARBUNCLES. 

A carbuncle is an acute, circumscribed, phlegmonous inflam- 
mation of the skin and subcutaneous structures, terminating* in a 
slough. They are seen in those of middle to advanced age, more 
commonly in men, and most frequently upon the nape of the neck 
and upper part of the back. There is rarely more than one at a 
time. The carbuncle usually begins with malaise, chilliness and 
febrile disturbance. There is a firm, flat, inflammatory infiltration 
in the deeper skin and subcutaneous tissue spreading laterally and 
finally involving an area of from one to several inches in diameter. 
As the infiltration and swelling increase the skin becomes of a 
dark red color and, sooner or later, at the end of ten days or two 
weeks, softening and suppuration begin to take place and the skin 
finally gives way at small points through which sanious pus exudes. 
The whole mass at last sloughs away, either in portions or in its 
entirety, resulting in a deeper ulcer, which slowly heals, and leaves 
a permanent scar. In some cases, especially in old people, sympa- 
thetic constitutional disturbance of a grave character is an accom- 
paniment. Blood poisoning is sometimes developed and a fatal 
result may ensue. 

The same causes are considered operative in a carbuncle as in 
furuncles; general debility and depression predisposing to its 
formation, and the introduction of the microbes peculiar to this 
affection. Inflammation starts at the same time from several 
points — from the hair follicles, sweat glands, or sebaceous glands 
— the inflammatory centers break down and the pus finds its way 
to the surface, the process ending in a general slough. 

When carbuncles occur about the head their development 
should always be carefully watched and proper remedies applied. 

Treatment. — At the early stage the formation should be in- 
jected with a five or ten per cent solution of carbolic acid, or the 
whole surface may be covered with a twenty-five-per-cent ichthyol 
ointment. Where there is breaking down of the parts, a cupping 
glass may be used to withdraw the pus, and carbolized glycerin or 
carbolized water introduced into each opening, and ichthyol oint- 
ment afterward rubbed in. If the process is slow, with a tendency 
to sloughing, the ulcer should be scraped out and dressed anti- 
septically. Bathing the site of the carbuncle with the bichloride 
solution, as with boils, to prevent the formation of more carbuncles, 
should not be neglected. The constitutional treatment consists 



DISEASES OF THE SKIN. 073 

of the free administration of the chloride of iron. Give ten to 
twenty drops in one-third of a glass of water every four hours. 

ANTHRAX. 
(Malignant Pustules.) 

Malignant pustule is a lesion, somewhat like a furuncle or car- 
buncle, resulting from virus generated in an animal suffering from 
splenic fever, and is accompanied by constitutional symptoms of 
more or less gravity. A fatal termination is not unfrequent. It 
is due to the bacillus anthracis. 

Treatment. — The part containing the point of inoculation 
should be immediately cut out, care being used to remove all the 
tissues that have become infiltrated with the poison, and to thor- 
oughly wash the wound in a one to one thousand solution of bi- 
chloride of mercury, then to cover it with iodiform gauze. Some 
prefer cauterizing with a hot iron, and injections of a hve-per-cent 
solution of carbolic acid are sometimes used, but, unless applied 
at a very early stage of the disease, the knife is the surest remedy. 
This, however, cannot always be employed, as when the swelling 
has become great and the infiltration widely extended, so that ex- 
cision is impracticable. In such cases injections may be the last 
resort. The needle of the hypodermic syringe should be inserted 
full length and the fluid thrown in as the syringe is being with- 
drawn. This should be repeated a half dozen times or more, at 
different places within the border of the swelling, that the acid may 
reach every portion of the affected tissues. These injections 
should be repeated every four or five hours, until the swelling is 
checked or there appear symptoms of carbolic poisoning. When 
there is edema, free, deep incisions should be made over the 
infected region and the wounds copiously irrigated with strong 
antiseptics, care being taken to get them into the wounds very 
thoroughly. The above named bichloride solution is probably as 
good as any for this purpose. Use ice bags over the part infected. 
Tonics and stimulants should be given internally. When there 
are symptoms of general infection, alcohol is recommended in 
large doses. Quinine may also be given. When the poison has 
been subdued, poultices should be applied to the wound until the 
deadened parts slough away, after which it may be healed. One part 
of carbolic acid in six of pure olive oil makes an excellent dressing. 



43 



674 . DISEASES OF THE SKIN. 

ERYSIPELAS. 
(Rose. St. Anthony's Fire.) 

Erysipelas is an acute, infectious inflammation of the skin 
and subcutaneous tissues, is characterized by shining redness, 
smoothness, swelling and heat of the part affected, and a ten- 
dency in some cases to vesicles, and is accompanied by more 
or less fever. 

It was formerly considered as of two kinds : The idiopathic, 
or that which first appears upon an unbroken skin ; and the 
traumatic, or that which begins in wounds or abrasions; but it 
is now known that all cases of this disease are due to one and 
the same cause, the germ streptococcus erysipclatis, which, hav- 
ing gained an entrance to the skin, multiplies and produces a 
poison that gives rise to the various manifestations seen in the 
different cases. Some hold that the germs are able to effect 
an entrance through the skin only where it is broken and that 
this lesion may range from the slightest scratch to the severest 
wound ; while others, seemingly with as good logic, contend that 
it may also enter when there is no abrasion if the skin be in a 
low condition of vitality, as when the patient has been suffering 
from some other disease, from poor nutrition, dissipation, bad 
air, a long period of protracted heat, overfatigue, etc. Certain 
it is that in this class of persons the disease is quite frequent 
and that it seldom attacks those in robust health. It is most 
common, however, in young infants and adults from twenty to 
thirty years of age, in women during menstruation and the lying- 
in period, and in those suffering from wounds. The navel of the 
newborn and the breasts and genitals of the parturient woman 
are especially liable to its attacks in cases where proper attention 
has not been given to cleanliness or the surroundings are bad. 
It formerly swept through the surgical and lying-in wards of 
hospitals with such mortality as to make "hospital erysipelas" 
a terror greatly to be feared, but now, thanks to the discov- 
ery of the germ causation of disease and of aseptic and anti- 
septic methods of controlling infections, it would be considered 
an unpardonable disgrace to the management of any hospital 
to permit even a few successive cases to occur within its walls. 

A mild form of the disease is often seen at the outlet of 
the nostrils, taking its origin from an inflammation of the hair 
follicles just within the nose, but these cases are usually without 



DISEASES OF THE SKIN. 675 

serious constitutional symptoms. A mild form of erysipelas is 
also sometimes seen upon the fingers and hands, starting in 
some little wound that becomes infected with the erysipelas 
germs; but in cases in which the deeper tissues and organs be- 
come involved the disease is a much more serious matter and is 
likely to be accompanied by grave constitutional manifestations. 

Symptoms. — The disease is ushered in by a feeling of chilliness 
followed by fever, though for a period varying from a few to 
twenty-four hours there is likely to have been headache, gen- 
eral depression and poor appetite, if not vomiting. The eruption, 
when first seen, is likely to be a patch an inch or more in diam- 
eter, of bright red color, slightly raised or swollen, smooth and 
shining. The redness disappears when pressed, but reappears 
as soon as the pressure is removed. Gradually increasing, the 
inflamed area gains its greatest size in a week or ten days and 
may then vary from a patch three inches across to one very much 
larger; a day or two later it gradually subsides, loses its color 
and ends in scaling or peeling. Dr. Hyde says : "Until the 
inflamed area reaches its greatest extent the fever continues, 
and may go as high as 106 degrees, is likely to be highest at night, 
and to be accompanied by pain in the stomach, head and back. . . 
Sometimes pustules and small blisters form and gangrene of 

the skin may folloAv Sometimes the inflamed area seems 

to advance, extending on one side as it heals on the other." 

Treatment. — Purge by giving the patient Epsom salts, a 
tablespoonful every three hours, until the bowels move freely. 
Follow with tincture of chloride of iron and quinine, one-half 
dram quinine to one ounce tincture of chloride of iron, giving 
ten to twenty drops every four hours. 

Bathe the part with a saturated solution of boric acid, then 
smear it with ichtliyol ointment. The affected part may be painted 
with tincture of iodine, covering a margin of the healthy skin 
to prevent the disease from spreading, for although this is not 
always successful it sometimes is. The remedy is a severe one 
for thin skinned people, hence for children and females whose 
skin is delicate lotions of sugar of lead may be used instead. 
They relieve the burning and soothe the inflammation and are 
a most valuable remedy. 

Powdered boric acid may be dusted upon the reddened 
part, then a covering of several thicknesses of cloth, neatly cut 



676 , DISEASES OF THE SKIN. 

to the size and shape of the inflamed patch, may be wrung out 
of cold water and so applied that its edges shall not extend beyond 
the borders of the reddened area. Patients to whom cold is agree- 
able may place over this an ice bag. Unless accompanied by 
some other disorder erysipelas runs a favorable course and 
terminates in recovery in from one to three weeks, but in cer- 
tain conditions it is a very dangerous disease. Fortunately, 
perfect safety can usually be obtained at these times by using 
proper precautions against contracting this disorder. 

From what has already been said it will be understood 
that it is very important that women recently delivered or about 
to be confined, newborn infants, anyone suffering from wounds 
or sores, and the weak and debilitated, should never be allowed 
to remain in the same house with a case of erysipelas, unless the 
sick-room be far removed and wholly cut off from the living 
rooms, no one be allowed to pass from the sick room to the other 
rooms, and unusually thorough and efficient precautions be taken 
in the line of ventilation, cleanliness and disinfection, to prevent 
the dissemination of the disease. 

In days which we hope are all gone by, many a physician, 
from failing to properly cleanse his hands, face, beard and hair, 
or to don clean clothing in place of that infected with erysipelas, 
has carried death, in the form of so-called puerperal fever, to a 
patient in labor or the lying-in, and, later, it may be, in common 
with the friends of the loved one, has wondered at the strange 
dispensations of Providence in removing while in her prime the 
light and very life of her home. (See Care of Infectious Dis- 
eases in the department upon Nursing.) 

LENTIGO. 
(Freckles.) 

Freckles are round and irregular, yellowish, brownish or 
blackish spots, of pinhead to pea size, usually occurring on the face 
and backs of the hands. The affection is a very common one and 
varies in degree of development. The spots may be few and in- 
significant or may be so abundant as to greatly disfigure the com- 
plexion. They are generally caused by exposure to heat and wind 
during the summer season. Those of light complexion, with light 
or red hair, are most liable to this trouble, especially when the spots 
are of a reddish brown color. Freckles consist of deposits of pig- 



DISEASES OF THE SKIN. 677 

ment within the mucous layer of the skin They can be removed 
by proper treatment, but are liable to return. 

Three grains of corrosive sublimate in an ounce of water 
makes a wash that applied three times a day usually removes the 
spots, and is one of the best remedies, but it is poisonous and 
should be used with care. It must not be applied to a very large 
surface. 

From one to six parts of lactic acid to twenty parts of water 
mav be used. Five to ten grains of salicylic acid in an ounce of 
water, and applied three times a day, has been recommended. 
Either of the following stock prescriptions may be applied several 
times a day : 

Subnitrate of bismuth '. one dram 

Ammoniated mercury one dram 

Rose ointment one ounce 

Or, Bichloride of mercury ten grains 

Almond emulsion six ounces 

Tincture of benzoin one dram 

CHLOASMA. 

(Liver Patches.) 

This disorder is characterized by single or multiple discolora- 
tions of the skin, varying in shade from a light yellow to a reddish 
brown, or even a blackish hue. It occurs in well defined patches, 
usually symmetrically distributed over the face, but sometimes 
found upon other parts of the body. Like freckles, the spots are 
produced by excess of pigment in the mucous layer of the scarf 
skin. The corium is not involved, but in some cases the blood ves- 
sels in the papilla? have been found in a somewhat dilated condi- 
tion. By bringing an excess of blood to the skin, these vessels 
were agents of the disorder, for it is from the blood that the pig- 
ment is derived. Those parts naturally most shaded with pigment 
are the places where the disease is most likely to appear. 

The causes are many and varied. External injury is one of 
them; disease of the suprarenal capsules, and of the liver, is an- 
other very frequent one, and disease of the womb is sometimes 
given as a cause, but it is likely that these cases are really due to 
liver trouble, as diseases of the womb and liver often go together. 
When due to inaction of internal organs, the spots are generally 



678 - DISEASES OF THE SKIN. 

distributed over the body, but when caused by external injury, 
they are circumscribed and confined to the locality injured. Again 
the spots are sometimes due to micro-organisms. 

The treatment must vary according to the variety of the af- 
fection. If caused by external injury, rubbing the part in warm 
water is usually sufficient, the spots disappearing after a few days. 
If of germ origin, the spots should be bathed three times a day in a 
solution of bichloride, of mercury — from two to four grains to the 
ounce of water. If from a disordered liver, the treatment should 
be directed to that organ and the general health improved, when 
the spots will probably disappear. Always' be careful in the use 
of the bichloride of mercury and not spread it over a very large 
surface, lest poisoning result from absorption. 

DISORDERS OF THE SWEAT GLANDS. 

Defective Szveat. — This is a disorder which may be local or 
general, congenital or acquired. There may be only slight diminu- 
tion, or a complete absence of perspiration. Many people, for no 
apparent reason, sweat but little or none at all. The 
disorder is a symptom of some other disorder, as of 
fever at certain stages, diabetes, Bright's disease, etc. Local and 
circumscribed anidrosis is due to some injury of the sweat glands. 
It produces no particular disturbance until the patient is placed 
under conditions that should cause perspiration. The treatment 
should be stimulation of the sweat glands of the skin with pilocar- 
pine, warm baths and massage. Do not resort to pilocar- 
pine until a thorough use of the other remedies has failed to give 
relief. 

Hyperidrosis (Excessive Sweat). — This is a disturbance of 
the sweat glands in which the secretion of perspiration is excessive. 
Under many conditions a large amount of sweat is normal. All 
persons should perspire freely after severe exercise, after drinking 
much cold water, and when under the influence of strong emo- 
tions. Excessive sweating is most common in the palms, soles 
and axillae. Wherever it is very frequent and profuse it is asso- 
ciated with enfeebled condition and want of general tone. The 
horny layer of the skin of the parts affected has a translucent, lus- 
terless appearance, due to its softening. When long continued, 
the softened epidermis loosens and peels off in Hakes, especially 
on the soles, causing discomfort. The borders of the soles are red- 
dened and, in case there is much walking, blisters sometimes form. 



DISEASES OE THE SKIN. 679 

Treatment. — Wet the affected parts with alcohol, containing 
one per cent of quinine, then rub upon them powdered starch or, 
what is better, subnitrate of bismuth. If the trouble be with the 
feet, sprinkle bismuth freely in the stockings also. Another good 
treatment consists of soaking the feet in warm water, then pouring 
over them a strong solution of salicylic acid, afterward rubbing 
them with one part powdered boric acid in live parts of talc. It is 
well to have several pairs of cork insoles for the shoes, that a fresh 
pair may be used every day. Each night take from the shoes 
those worn through the dav and, havine disinfected them, lav them 
away to dry. The soldiers of the German army rub their soles 
each night with a two-per-cent ointment of salicylic acid and mut- 
ton tallow, to check perspiration and toughen the skin. 

Bromidrosis. (Offensive Sweat). — This affection is a de- 
rangement of the functions of the sweat glands in which the per- 
spiration has an offensive odor. It may be sweet, or sour like that 
of beer, or of freshly baked bread, or wet straw. The offensive- 
ness is due to decomposition of the macerated portions of the 
scarf skin and of the sweat after its excretion. As the perspira- 
tion of different persons differs in composition and quantity, its de- 
composition products will vary in character and odor. The sur- 
faces affected have a soaked and sodden appearance. 

The bromidrosis most often demanding attention is that of 
the feet and axillae. The feet of some young people, whose occu- 
pations require much standing or walking, perspire very freely 
and, in bad cases, the resulting odor is so penetrating as to be offen- 
sive, even through the shoes, so that the patient is forced to shun 
society and is unfitted for many indoor vocations. 

Treatment. — After thoroughly washing with plenty of soap, 
one grain of bichloride of mercury in a pint of water is generally 
effectual, for, by destroying the germs of putrefaction, it destroys 
the odors. It should be rubbed over the offending parts with a 
soft cloth, morning and evening. 

PRURITIS ANI. 
(Itching Piles.) 

Pruritus ani, or itching piles, is of rare occurrence in youth. 
It is frequent among the aged, especially those of a nervous condi- 
tion, and the uncleanly, and is very common during middle life, 
when people are most prone to excessive table indulgence. From 



680 DISEASES OF THE SKIN. 

overfeeding and lack of sufficient muscular exercise there is dis- 
turbance of the general circulation, especially where the blood ves- 
sels are dependent, as in the anal region. Fullness of the veins re- 
sults and, where there is fullness of veins, there frequently is weep- 
ing of the tissues, accompanied by more or less itching and tend- 
ency to scratching. If this condition be continued for any con- 
siderable time, the skin around the anus becomes thickened, and 
often striated (gathered in folds). From the scratching, small, red 
papules or points, seated in the papillary layer of the skin, arise in 
the folds. 

The affection gives little trouble through the day, but at night, 
when the patient disrobes and cooler air strikes the body, the al- 
tered temperature lights up the irritation and the itching becomes 
almost unbearable, and he scratches for relief. In this way he may 
be kept awake for hours, until the temperature of the bed having 
become the same as that of the body the irritation gradually sub- 
sides. In such cases there is likely to be imperfect metabolic action 
(a clogged circulation in the liver and spleen). 

„ This condition is best relieved by a teaspoonful of sulphate of 
soda and ten drops of tincture of nux vomica, in a glass of water 
at bedtime, which should cause a free evacuation of the bowels 
the next morning. 

For the irritation at the anus, five grains of menthol to the 
ounce of vaseline, applied after thoroughly washing the parts and 
drying with a soft towel, relieves the itching and is a good remedy. 
To get rid of the thickened condition of the skin, equal parts of 
ichthyol and vaseline should be used every night until the skin 
is softened, when the excess of cuticle may be scraped away with 
a curette or dull knife, after which the ichthyol should be con- 
tinued until the parts become normal. Worry and anxiety should 
be prevented and physical exercise regulated. With these meas- 
ures, elate the patient by promising a certain cure. 

Symptoms similar to those of itching piles are sometimes due 
to the presence of seat worms, in which case a sharp cathartic and 
injections of quassia tea will bring relief. (See Intestinal Para- 
sites.) 



CHAPTER IV. 



THE HAIR. 



A hair is an appendage of the skin and has two parts, the 
shaft and the root. The transparent investment covering the shaft 
and root is called the cuticle. Each hair is implanted in a sack 
or pouch, which is called a follicle, is composed of connective tis- 
sue, is formed from the skin and sometimes involves the subdermic 
connective tissue layer. It opens by a mouth upon the outer 
surface of the skin, and has a neck and a constricted part just be- 
low the papillary layer, where the duct of the sebaceous gland 
enters, and ends in a wide base or extremity. It is really a 
dipping clown of the papillary and reticular layers of the skin to 
form a deep receptacle for the bulb-like root of the hair. Growing 
from the central and lowest part of the follicle is found a papilla, 
where this root is implanted. The follicle itself has two parts, an 
external and an epidermic coat. 

The external coat consists of connective tissue and has arter- 
ies, veins, and nerves, and to this coat are attached the hair muscles. 
The epidermic coat is formed by a turning inward of the rete 
(reticular layer). The horny layer of the skin reaches down only 
to the opening of the sebaceous gland, but the mucous layer con- 
tinues down to the papilla. The papilla is a connective tissue for- 
mation and is joined to the main body of the true skin, through 
the bottom of the follicle, by a pedicle in which are blood vessels 
for carrying nutrition. The papilla of a hair follicle contains many 
pigmented and non-pigmented corpuscles, also blood vessels, 
which at the apex form a loop similar to those in a derma papilla. 

The root sheath is made of two membranes. The outer one 
consists of finely granular pale cells with very indistinct nuclei. 
The inner layer is more coarsely granular and has shorter and 
broader many sided cells with distinct nuclei. The sheath ex- 
tends from the opening of the sebaceous gland down to the hair 
bulb, which is constituted by the reduplication of the inner layer in 
the bottom of the follicle, where it surrounds the papilla. The hair 

68 1 



682 , DISEASES OF THE SKIN. 

is produced from this root sheath. 'It begins to develop about 
the third month of fetal life, and rises from the central portion of 
the sheath. The formation of the root is analogous to that of the 
horny layer of the epidermis from the rete. 

The color of the hair depends not alone upon pigment, but 
also upon the presence of air bubbles. Blond hair is usually lack- 
ing in pigment. Curl in the hair depends partly upon the curve 
of implantation beneath the skin, and partly upon its shape. 
Straight hair is round and curly hair is eliptical, sometimes flat. 
The hairs upon the head are estimated at 1,000 per square inch, or 
about 120,000 in all. 

Care of the Hair. — The health of the hair requires light and 
air, hence heavy, unventilated hats are bad. Constant and severe 
mental strain and anxiety may cause baldness. Harsh and power- 
ful chemicals, such as are often used in shampoos, are very injuri- 
ous. Use only soaps of finest quality. The white of an egg and 
warm soft water make an excellent shampoo, but a better one is 
made of pure soft water and castile soap. It should be used often, 
after which rinse thoroughly and dry the scalp with towels. 

The regular use of pomades upon the scalp is unwise. They 
are dirty, soon become rancid, emitting a foul odor unless over- 
come by a strong perfume, and soil all with which the head comes 
in contact. Oiling the hair is unnecessary and a filthy habit. 
Sousing the head frequently in water is also bad. Use a dry brush 
freely every day and keep the scalp clean and healthy, and nature 
will supply what oil is needed. 

It sometimes happens that the hair from improper treatment, 
general physical debility, or other causes, becomes dry, brittle 
and apparently lifeless. The following tonic may then be rubbed 
on the scalp each morning : 

Sulphate of quinine twenty grains 

Enough dilute sulphuric acid to dissolve the quinine. 

Tincture of cantharides two drams 

Hazeline and glycerin each, one ounce 

Water of orange flowers eight ounces 

Hair Dyes. — Dyes are a disadvantage and injury to the hair. 
When used once they must be continued or the growth of the 
hair will reveal the true color at the roots, while the dyed portion 
tells of the vanity of the possessor. Better let dyes alone, but, if 



DISEASES OF THE SKIN. 683 

one must be had, the following is as good as any: Saturate the 
hair with a solution of nitrate of silver, five to ten grains to an 
ounce of distilled water, and let the hair dry in the sun. Applying 
a solution of sulphuret of potash, twenty to a hundred grains to the 
ounce of water, hastens the process. 

ALOPECIA. 
(Baldness.) 

By alopecia is meant loss of hair, either partial or complete. 
There are various forms of this disease, of which the most im- 
portant for our consideration are: 

i. Congenital Alopecia in which the tendency to baldness 
is hereditary. This is not very common, although a scanty 
growth of hair is a family peculiarity very often seen. When loss 
of hair begins with a person, one or more of whose ancestors were 
bald, the prospect is discouraging, for although it seldom goes 
on to total baldness, no remedy yet discovered seems to have 
much influence in checking its progress. 

2. Premature Alopecia. Excepting the congenital cases, 
loss of hair from natural causes before forty-five years of age is 
known as premature alopecia. There may be, or there may not 
be, external signs as to the cause. Anything that arrests the 
growth of the hair will lead to it. The natural life of a hair is 
thought to be from two to six years, after which it drops out, 
hence, unless the growth of the new hair is maintained to take the 
place of the old, the daily shedding of old hairs will soon result 
in baldness, more or less complete, according to the area involved 
by the abnormal condition. 

It is very likely to follow severe attacks of fever or other 
illness that greatly reduces the system, and sometimes results 
from nervous shocks, also from intense mental activity and anx- 
iety, in which cases it may be permanent, but is likely to prove 
only temporary, the hair resuming its normal growth as soon as 
the system regains a healthy activity. 

The most frequent local cause of this form of alopecia is dry 
seborrhea of the scalp, a disease said to be the principal cause of 
all baldness in women and occurring in them more frequently 
than in men. Among other local causes are ringworm of the 
scalp, erysipelas, small-pox and eczema, in fact, any disease long 
and severely affecting the scalp, also syphilis, and injury to the 
scalp, as from a bruise, bee-sting or friction. 



684 . DISEASES OF THE SKIN. 

Treatment. — This must consist of the removal of the cause 
if it can be ascertained. More can be done by restoring the 
health to the best possible condition than in any other way. 
The use of pilocarpine and jaborandi internally and externally, 
is recommended by some. Lassar gives the following formula: 

Pilocarpine hydroclorate thirty grains 

Vaseline live drams 

Lanoline two ounces 

Oil of lavender thirty grains 

Cottle gives this formula: 

Acetic acid one-half -ounce 

Pulverized borax one dram 

Glycerin three drams 

Spirits of wine one-half ounce 

Rose water eight ounces 

He also uses ammonia as follows : 

Liquor acetate of ammonia two ounces 

Carbonate of ammonia one-half dram 

Glycerin three drams 

Water sambucus eight ounces 

Apply to the scalp two or three times a day. 

The prevention of baldness is generally much easier than its 
cure; to this end the scalp should be kept clean by shampooing 
once or twice a month and by thorough brushing at least once 
every clay, but this must not be carried to the extent of irritating 
the skin. The head should not be soused in water, unless it be 
followed by a careful drying of the scalp with towels. A fine- 
toothed comb should never be used upon the hair, either of children 
or adults ; use instead a soft brush for children, a stirrer one for 
adults. The hair of girls as well as of boys should be kept short 
until they are eight years old. No attempt should be made to 
curl hair by the use of hot irons ; kinking in curl-papers and simi- 
lar devices also injures it. 

3. Senile Alopecia is the baldness that comes after forty- 
five. It may begin at the forehead and work back, but usually 
commences on the back part of the apex of the head and spreads 
in all directions, though it does not usually extend over the en- 
tire scalp. It is thought to be the first indication of the lessened 



DISEASES OF THE SKIN. 685 

vitality of advancing years, and is much more common in men 
than in women. It very rarely affects the beard, but may extend 
to the pubic region. There is very little use of trying to treat this 
form of alopecia. No remedy is known for it, and the loss of hair is 
permanent. 

4. Alopecia Areata is a form of baldness which appears sud- 
denly in one or more small circumscribed patches upon an ap- 
parently healthy skin. A slight itching or feeling of tension in 
the spots may precede, but usually there are no premonitory 
symptoms, and the appearance of a bald patch the size of a dime 
or larger is the first indication that anything is wrong. The 
spots are very white and smooth and a little depressed below the 
surrounding skin. Having thus begun, the disorder may spread 
until every hair on the body is removed, but generally after 
spreading a little goes no further. 

Its cause is not known. By some it is believed to result from 
disordered nerves; others maintain that it is the work of an ex- 
ceedingly minute parasite and that, although good lenses and 
patient investigation have thus far failed to discover it, the phe- 
nomena attending the disease can be explained in no other way. 

Fortunately the loss of hair from this form of alopecia is not 
often permanent, but after a time, varying from a few weeks to 
ten or more years, the hair is likely to grow again in the bald 
places, and in many cases it will be as thick and luxuriant as 
before the attack. Persons less than forty years old nearly al- 
ways regain their hair and many do at a much more advanced age, 
but the probability of their doing so diminishes as their years 
increase. The history of an early loss of hair by the ancestors 
is an unfavorable indication in this as well as in other forms of 
alopecia, but is by no means a positive sign that the patient will 
not fully recover. 

Treatment. — It is thought that internal remedies have very 
little effect, but hair growth is known to be stimulated by perfect 
health of the body, and for this reason as well as countless others, 
the general health should be made as perfect as possible. Alo- 
pecia areata tends to spontaneous recovery, and in many cases the 
hair will grow again without any treatment, hence it is never 
known whether the use of a remedy hastens the process, but the 
majority of authorities advise the use of such applications as will 
stimulate the scalp. For this purpose Crocker recommends 



686 DISEASES OF THE SKIN. 

chrysarobin ointment — a dram of the chrysarobin to the ounce of 
l ar( l — rubbing it into the skin of the bald patches well and thor- 
oughly night and morning. Its irritation of the patch, however, 
is liable to extend so far as to alarm the patient, and this is the 
chief objection to its use. It must not be used near the eyes in 
any case. 

Bisquet recommends that the hair be cut short and frequently 
disinfected by a strong solution of carbolic acid, that the 
scalp be kept dry at all other times, that the patches be 
treated with one part cinnamon oil to three parts sulphuric ether, 
and that when the slight redness thus produced disappears, the 
oil and ether be applied again. It is a germicide and excludes 
the air. 

Later, when the hair has ceased to fall out, the following 
recommended by Wilson is likely to do well : 

Strong ammonia liquor four drams 

Chloroform four drams 

Oil of sesamum four drams 

Oil of lemon one-half dram 

Spirits of rosemary four ounces 

Apply once or twice a day. 

Crocker advises the use of: 

Perchloride of mercury two to five grains 

Brandy one dram 

Oil of turpentine seven drams 

To be rubbed into and around the patches night and morning. 



VENEREAL DISEASES. 

By R. E. McVey, M.D. 

SYPHILIS. 

(Pox.) 

An enumeration of the causes of suffering is often unpleasant, 
but doubly so when the evils under discussion are venereal dis- 
eases, for a correct understanding of which it is necessary to call 
attention to the loathsome acts by which they are chiefly dissemi- 
nated. Would that, in a popular work for the home, the con- 
sideration of this class of subjects might be omitted, but these 
dreadful penalties for broken law are so widespread and alarm- 
ingly frequent, as every physician of even limited practice will 
testify, and the first advances toward ruin are so often made ignor- 
antly, we should fail in our duty to the rising generation did we not, 
by pointing out these dangers, show to the innocent some of the 
fearful consequences very likely to result from any turning aside 
from virtue ; for if inoculation should not occur at the first trans- 
gression, when the line has once been crossed, the barrier between 
purity and vice been broken, the weakened offender, robbed of 
self-respect and the restraints of conscience, will sin again and 
again, until chancroid, gonorrhea and syphilis may be among only 
the milder of the retributive consequences. The social evil is the 
greatest. blot of our times; and can it be explained on any other 
hypothesis than that of ignorance that thousands of bright young 
people should annually enter upon lives of shame, so surely and 
quickly leading to dishonor, disease and death? Shall we not, 
rather, let them know, while pure and innocent and before it is 
too late, where the uncurbed passions lead, and that verily it is 
the first step that costs? 

And the warning should not stop here, for of all diseases syphilis 
is the most transmissible to offspring, and the most fruitful cause 
of miscarriage, abortion and infantile mortality. Those affected 
with this awful malady should not be allowed to marry until time 
and treatment have thoroughly done their cleansing work, a 

687 



688 , VENEREAL DISEASES. 

process usually accomplished in four years of vigorous continued 
medication, although instances are not wanting in which men, 
infected and supposedly cured in early life, after twenty years of ap- 
parent freedom from the disease have begotten syphilitic children. 
Every syphilitic husband should be plainly told that "he may in- 
fect his wife directly by sexual contact, or indirectly through the 
medium of the fetus, and that if she fails to abort, she may be 
delivered at term"* of a wasted, wizened, deformed, feeble, snuf- 
fling, blotchy child — blasted from the beginning- — which, if it does 
not die within a few months after birth, as nearly 50^ of all such 
infants do, is likely to succeed to a stunted development, mental 
incapacity, and a heritage worse than death. "Every wife should 
be informed that by permitting the approaches of a syphilitic hus- 
band she herself becomes liable to the disease,'' and to a mother's 
share in the creation of such a being as just described; and all 
adults should so fully understand the possibilities of contamination 
as to be able to intelligently protect themselves, their children and 
friends from all indirect infection , as from servants, playmates, 
soiled bedding, towels and utensils of every kind. 

Syphilis is a very chronic as well as contagious disease. The 
mildness or severity of its manifestations, their multiplicity, suc- 
cession and duration, depend in great measure upon the con- 
stitutional peculiarities of the patient. It has long been supposed 
! to be of microbic origin, but, though many skillful investigators 
have made patient search for it, the germ has not been found. 
While we hope to give a good general idea of syphilis, and such 
information as shall serve as a note of warning, we shall not in the 
limited space at our disposal attempt its full discussion. The com- 
plete course of the disease consists of three parts : The Primary, 
Secondary and Tertiary Stages. 

The Primary Stage has been defined as the time during which 
the force of the disease seems to be concentrated at the point of 
infection, and in the adjacent lymphatic glands. When syphilitic 
virus is introduced into the system, there is no appreciable sign of 
its action until from twenty to thirty days, or more, when a single 
sore, called the primary sore, chancre, or initial lesion, appears 
upon the skin or mucous membrane at or very near the place 
where the virus entered. If inoculation occurred at more than one 
place, there will be more than one such sore. The chancre is 

* Genito-Urinary and Venereal Diseases, by White and Martin, D. Appleton & Co. 



VENEREAL DISEASES. 689 

round or oval, usually ranges in size from a pin's head to a dime, 
and has a dark red, somewhat depressed base, around which, 
especially in men, the tissues are apt to be firm and hard. Unless 
irritated, this ulcer does not suppurate, but discharges a small 
quantity of thin serous secretion which is very contagious. Unless 
the constitutional condition of the patient is bad, this ulceration is 
not likely to go very deep. It is not painful, and usually in three or 
four weeks disappears. 

At the same time that the chancre is developing, the lymph 
vessels and lymph glands of the adjacent parts become involved, 
swell and harden, and, extending back from the chancre, usually 
appear to the touch like hard, painless cords. With the subsi- 
dence of the chancre, these lymphatic enlargements, called syph- 
ilitic bubo, also disappear. The duration of this stage is from six 
to eight weeks, rarely longer. 

An interval of from two weeks to six months now follows, and 
as the general health has not been impaired, the patient may think 
that he is entirely free from the trouble, but is likely to find later 
that the poison has been slowly extending to the other lymph 
glands and spreading through his system. Whether in the first 
place the poison enters through the lymphatic vessels or through 
the blood vessels is uncertain, but it is probable that the blood is 
infected through the lymph by way of the thoracic duct. As the 
blood becomes infected its red corpuscles are diminished, and its 
white ones increased in number, and the entire system, especially 
the skin, becomes saturated with the poison. 

The Secondary Stage. — This and the tertiary stage, and the 
interval between them, make up the period during which the dis- 
ease is known as constitutional syphilis, because by the beginning 
of the secondary stage the body has become so thoroughly im- 
pregnated with the virus. 

In some cases the first manifestation of this stage is a red 
blush or rash, which, appearing mainly upon the chest, belly and 
other parts covered by the clothing, and causing no itching or 
pain, may escape the patient's notice and pass off without his be- 
ing aware of any secondary symptoms, the disease having ex- 
hausted itself without making any further skin manifestations. In 
such a case we cannot be sure that the patient has had constitu- 
tional syphilis. 

When preceding the. rash there has been fever, accompanied 



690 ' VENEREAL DISEASES. 

by pains, aching in the bones, and other neuralgic symptoms, and, 
perhaps, enlargement of the lymphatics, we expect the first blush 
will be followed by the papular form of the eruption upon the 
skin, which is the typical form of this secondary manifesta- 
tion ; there is, however, great variety in the character and severity 
of the eruptions in different cases. The papular eruption involves 
the deeper layers of the skin, and usually makes its appearance 
in from three to four months after the initial lesion. Its duration 
is from six months to two years. It is not likely to be painful, nor, 
except upon the hairy parts, to cause much itching. At first it is 
of a dark red hue, having the appearance of the chancre, but grad- 
ually changes to a paler color and assumes a more coppery or 
lean ham appearance. 

The moist papules are of special importance, though they are 
only ordinary papules transformed. Their transformation is due 
to their location, papular development being favored by fineness 
of skin, thin epidermis, and the moisture of secretions or excre- 
tions — conditions which are found at the junctures of the skin 
with mucous membrane. Upon the skin side a papule is often dry 
and scaly, while upon the mucous side its covering is softened by 
moisture and transformed into a grayish white, easily detachable 
membrane. In the mucous membrane of the mouth or throat 
these moist papules are known as mucous plaques or patches, and 
occur upon the inner surface of the cheek, at the juncture of the 
tonsil with the pharynx, sometimes on the tonsil, tongue, or lips. 
They are sometimes so large as to spread over a large part of the 
tongue; they have red bases, are somewhat circumscribed, and 
gray in appearance, as if they had been touched with a stick of 
silver nitrate. See Figs, i and 2, Plate IX. 

These mucous patches arrive early in the secondary stage, 
sometimes even before the skin eruption, and are the most con- 
stantly present of all the lesions of secondary syphilis, are quite 
diagnostic of the constitutional infection, and very contagious. 
What is known as innocent syphilis is conveyed by them, and on 
this account great care should be taken about kissing. The cus- 
tom may well be confined to special friends who are known to 
be pure. Much danger lurks in public drinking cups; if obliged 
to use them, always rinse thoroughly before putting them to the 
lips. In view of the fact that this, as well as many other most 
serious diseases, may be disseminated by such means, what can 




* 




* 



VENEREAL DISEASES. 691 

be too strong a condemnation of the custom in many of our schools 
of using public books and pencils, indiscriminately passing them 
from one pupil to another? 

Innocent syphilis may also be obtained by a wife from her 
infected husband, by a husband from his wife, by a wet nurse from 
a syphilitic child, by a healthy child from a syphilitic nurse, or 
from a healthy nurse who at the same time is also nursing a 
syphilitic child, or by any person, through any agency, such as 
an infected towel, brush, razor, pipe, knife, fork, bath tub, or 
privy seat, whereby virus from a syphilitic ulcer may be conveyed 
to a scratch or abraded spot upon his skin. The blood of a pa- 
tient suffering from constitutional syphilis will also impart the 
contagion. 

It may thus be seen that there are many ways of obtaining 
this disease, but the great majority of cases are acquired through 
impure sexual congress, so great, indeed, that but for this method 
of dissemination, syphilis, in a few generations, could be banished 
from the earth. 

In cases acquired through kissing, the initial lesion will be 
found on one of the lips, and will be readily transformed into 
a mucous patch, which may continue through the entire secondary 
period of the disease, with tendencies to relapse. The changes 
which occur in the mucous patches are of the same general nature 
as those in the papules upon the skin, but the chronological or- 
der in which these patches appear is by no means as regular as 
in the skin manifestations. 

The Tertiary Stage. — From the best information on the sub- 
ject, a large per cent of syphilitic cases terminate with the second- 
ary symptoms, the disease having been overcome by the vital 
forces of the body. About seven per cent of all cases, however, 
pass into the tertiary stage. When this stage is reached the dis- 
ease has so lost its constitutional characteristics, that its manifesta- 
tions are localized. This statement is difficult to harmonize with 
the accepted theories of the primary and secondary stages. The 
important factor in the first stage is probably a germ. The mani- 
festations of the tertiary stage cannot be reconciled with the 
presence of a germ, as in the first two stages. The impress of 
the disease has been more intense in some parts of the body than 
in others, and we have proliferation of connective tissue cells, 
which, losing their vitality while maturing, break down into the 



692 VENEREAL DISEASES. 

gummatous ulcer, or gumma, so-called because its contents re- 
semble gum. When these formations are situated upon the skin, 
and often when upon a mucous membrane, they form large indolent 
ulcers with sharp cut-out edges surrounded by swollen, hardened, 
inflamed tissue, affording little pain and varying greatly in size 
and appearance, according to the peculiar bodily conditions of the 
'patient. Such a gumma is shown in Fig. 3, plate IX. They may 
appear upon any part of the surface, but their favorite sites are 
the face, arms, the upper front portions of the legs, the breast, 
scrotum, penis, and the external genital organs of women. They 
may be single or multiple. When two or more are near together 
they are likely to unite, forming one large irregular-shaped sore. 
Any mucous membrane may likewise become the site of a gum- 
matous ulcer, but the throat, vagina, urethra, inner surface of the 
prepuce, the labia and the anus are, perhaps, most often thus af- 
fected; they are also quite frequently found in the nose and the 
rectum ; in fact, any part of the alimentary canal may be visited in 
this manner. 

The muscular gummata are those formed deep in the tis- 
sues, and instead of becoming soft in the center and ulcerating, 
remain hard, increasing in size until they sometimes become 
larger than a full grown lemon. 

They are liable to form in the liver, mesentery, spleen, lungs, 
heart, arteries, spinal cord, brain ; in short, no organ of the body 
is exempt from them. Ulceration of the bones is also a mani- 
festation of tertiary syphilis. 

The diagnosis of syphilis in the primary and secondary forms 
is not usually difficult, but this is not true of the tertiary stage, 
unless there are scars from the primary or secondary lesions. It 
may rarely happen that a patient has had the first stages of 
syphilis without knowing it, and in such an instance it is very diffi- 
cult to get a history of the case that is satisfactory. Many ob- 
scure infectious symptoms, which also belong to the non-syphilitic, 
may be found in those who have had syphilis, and the difficulty 
now comes up, whether to attribute these vague symptoms to a 
syphilitic taint or to some other cause. The prospects for re- 
covery in syphilis are very good in the majority of cases, but not 
so in those showing the brain and nervous manifestations. There 
are very few deaths, in the acquired cases, arising -from the cir- 
cumscribed gummatous form seen in the later stage of the dis- 
ease. 



VENEREAL DISEASES. 693 

Treatment. — First local. At the first appearance of the 
chancre the diagnosis is quite uncertain until after the drying or 
hardening takes place. Simultaneous with this hardening the 
lymphatic glands in the groin or axilla become inflamed and en- 
larged. This occurs about the beginning of the second week. A 
solution composed of one part of the bichloride of mercury to one 
thousand parts of water may be injected hypodermically under the 
chancre, or the chancre may be treated by electrolysis, if thought 
to be a local disease, but in other cases treatment by mercury 
should not begin until the appearance of the second stage of the 
disease. It should be remembered that mercury is not eliminated 
from the system in less than six months from its inception, and 
the poisonous effects of this remedy should be thoroughly under- 
stood. These effects are first seen by alterations in the character 
of the saliva, which becomes increased and stringy. When the 
system becomes saturated with mercury, there is a metallic taste 
in the mouth and a strong, offensive breath. 

Slow mercurial poisoning gives rise to nervous troubles, 
trembling in the muscles, sclerotic plaques in the brain and spinal 
cord, convulsive phenomena, epileptic attacks, choreic and apoplec- 
tic symptoms, paralysis and disturbances of sensibility — results 
more serious than syphilis itself. If with a one to one thousand 
solution of bichloride of mercury, we mix an equal quantity of 
syphilitic virus, the virus is rendered harmless. Many eminent au- 
thorities agree that mercury cures syphilis, but, by common con- 
sent of the profession, the large doses, as formerly given, have 
been discarded and succeeded by small and more frequent ones. 

Perhaps the best form of mercury for syphilis is mercury with 
chalk (hydrargyrum cum creta). Where there is debility, com- 
bine with this a little quinine, giving a grain of each three times a 
day, and, if it produces griping or intestinal disturbances of any 
kind, add a grain of opium to each dose. If mercury in any form 
produces griping or diarrhea, it may be combined with opium. 
Never take mercury continuously. If the dose of syphilitic poison 
has been heavy and the constitutional symptoms are plain, con- 
tinue the treatment twenty days, then stop ten. If the constitu- 
tional symptoms are slight, continue the treatment ten days, then 
leave off twenty. Never forget the serious danger of taking into 
the system too much of this powerful drug. I would rather have 
syphilis and trust to the resources of the system to eliminate and 



694 VENEREAL DISEASES. 

cure the disease, than be treated for syphilis by an inexperienced 
physician who does not see his way clearly in reference to its 
elimination, the character of his remedies, and their subsequent 
effects. 

Great patience, as well as careful treatment, is required; and 
it is in this that many patients make very costly mistakes. Be- 
cause the eruption has disappeared and the general health is not 
impaired, they conclude that they are rid of the poison and quit 
the remedies. Experience has shown that the mercury, as above 
indicated, should be taken for two years; then during the first 
six months after the two years, what is called the mixed treat- 
ment should be taken, according to the following formula : 

Bichloride of mercury two grains 

Iodide of potassium four drams 

Tincture of gentian compound four ounces 

Dose for an adult, a teaspoonful three times a day. 

After six months of this treatment the iodide of potassium 
should be taken alone. There is quite a difference of opinion in 
the profession as to the amount of the iodide that should be given 
from day to day. I do not think it should exceed three drams 
per day — three doses of one dram each. 

In the tertiary stage, if there be any uncertainty as to the 
symptoms being caused by the syphilitic virus, the tolerance of 
the iodide is considered evidence of the continuance of the dis- 
ease, for were it not for the presence of the virus the system 
would revolt and the indications of iodide poisoning would ap- 
pear. It is not quite settled as to how the iodide acts in removing 
the disease, but it is probable that the mercury destroys the germ 
or virus during the active stages, and that the iodide causes the 
elimination both of the mercury and the virus debris. 

The best method of taking the iodide is to combine an ounce 
of iodide with an ounce of water, and commence with a small 
dose, from five to ten drops, and increase it one drop each time 
until a dram three times a day is reached. The circumscribed 
gumma usually melts away under this treatment. 

The diffuse form, as found in the brain and spinal cord, does 
not yield to the iodides, and the question to decide is whether the 
patient is suffering from local effects of the syphilis, or from the 
mercury that has been absorbed. It may be with the mercury in- 



VEXEREAL DISEASES. 695 

stead of the syphilis that we have now to contend, in which case 
there is still hope. I have in these cases used one-sixtieth of a 
grain of strychnia and three or four drops of dilute phosphoric 
acid after meals. This quickens the action of the ceils in the 
brain and spinal cord, producing a more healthy action, invigorat- 
ing them, and serving all purposes better than the iodides. 

The best authorities agree that only the brain and nervous 
forms of syphilis are incurable. I believe it to be a disease of 
self-limitation and that a large percentage of the cases will re- 
cover without any treatment, but, as no one can foretell which 
cases will terminate so happily, it would not be good practice 
to rely upon this. Had I syphilitic iritis, I would be slow to let 
anyone operate upon my eye. Such an operation is attended by 
such great danger that it is safer to trust to nature's forces to 
throw off the disease. 

The old method of excision of the chancre has been discarded, 
for the virus was too often found to have already spread beyond 
the points that could be reached by the knife. Let no man give 
you mercury in the tertiary stage. Remember that the chancre 
belongs to the primary, the papule to the secondary, and the 
gumma to the tertiary stage. 

In Spain they do not use mercury. The climate alone seems 
to cure the disease, and during the seventeenth century, when 
mercury failed, the patient was sent to that country. In the 
United States, the various hot springs are the resort of all seriously 
syphilized patients. Hot water baths, ranging in temperature 
from 98 degrees to 104 degrees Fahrenheit, by stimulating per- 
spiration and the other excretions, greatly aid, especially in the 
elimination of mercury, from those who have been heavily dosed 
with the drug, but excellent authorities have found hot air baths, 
from 175 degrees to 200 degrees, and lasting from fifteen to 
twenty minutes, more valuable than hot water. They can be 
taken very easily in nearly the same way as described in this work 
under the head of vapor baths, but it must not be forgotten that 
baths alone will not cure syphilis. No matter how great the 
benefit thus derived, or how well the patient may feel for a little 
while following, the medication must be continued the full time 
to completely eradicate the poison from the system. The ad- 
ministration of mercurial vapor baths was never satisfactory, and 
is no longer considered good practice. 



696 . VENEREAL DISEASES. 

Probably no other class of unfortunates are so often imposed 
upon, so financially bled, as those suffering from venereal dis- 
eases. Stung by remorse, fearing exposure, and alarmed by 
vague terrors, they become the easy victims of extortionate quacks 
and advertising charlatans. Next in importance to knowing that 
the only sure way of escaping the greatest danger of becoming 
infected is in living an absolutely pure life, is the knowledge that 
your own faithful and reliable family physician is the one to re- 
ceive your fullest confidence as soon as you learn that anything 
is wrong. In the hands of no one else will you be as safe, for he 
will neither betray nor rob you, will be accessible at all times for 
counsel and guidance through the years of treatment which must 
follow, and is likely to be far more competent and skillful than 
the traveling mountebank who is unable to succeed by building 
up a practice where he is known. 

GONORRHEA. 
(Clap.) 

Gonorrhea is a specific disease, contagious, and communicated 
through impure contact between the sexes. It is considered a 
local disease, caused by the germ gonococcus, which, in the male, 
insinuates itself within the mucous membrane of the urethra, where 
it causes an inflammation, either mechanically from its presence, 
or by a ptomain. In the earlier stages of the infection, the dis- 
ease is confined to the outer openings of the genital tract, but 
often the deeper portions are soon invaded, especially in the 
chronic forms of the disease. 

In the male the membranous and prostatic portions of the 
urethra, and frequently the testicles, are involved by absorption. 
There is likely to be swelling, redness and soreness, and some- 
times pain in the penis. The germ is also frequently found in 
the bladder and the pelvis of the kidney. The virus may be ab- 
sorbed and taken up by the serous membranes of the joints, as is 
frequently seen in gonorrheal rheumatism in the ankles, knees, 
etc. It is also found in the heart. 

In the female the gonococcus is not confined to the urethra, 
being often found in the mucous membrane of the vagina, but the 
inflammation is not likely to cause her nearly as much trouble and 
anxiety as occurs in male patients. The uterus is involved, and 
especially the Fallopian tubes, where it is known as pyosalpinx. 



VENEREAL DISEASES. 697 

When these tubes become affected there may be a discharge of 
pus for many years. 

In the urethra of the male the inflammation often results in 
contractions of the canal, which are known as strictures. These 
are found about one and a half inches from the mouth of the 
urethra, also in the membranous part of that organ. In the 
chronic form the inflammation in the prostatic portion of the 
urethra may be very slow and mild, continuing many years, with 
more or less pain during urination, finally in old age resulting 
in obstruction of the urine and chronic inflammation of the bladder. 

Symptoms. — In from three to five days after the impure con- 
tact the first symptom appears and is a distressing itching near 
the meatus of the urethra, with more or less burning during uri- 
nation, which, in a short time, is followed by a peculiar yellowish, 
muco-purulent discharge, which, in the typical form of the dis- 
ease, continues three months, in some cases a year. There is 
an abortive form, which may not be specific and is the result of 
leucorrheal discharge, which mav continue only a few davs or a 
week, then disappear. One having gonorrhea, after handling the 
parts, should always wash the hands with soap, or some disin- 
fectant, to avoid infecting the eyes, for the germ or virus intro- 
duced into the eye produces gonorrheal ophthalmia, an inflam- 
mation which soon results in destruction of the tissues and total 
blindness. The patient should be quarantined from the other 
members of the family and his clothing should always be thor- 
oughly disinfected before being handled or sent to the wash. 

Treatment. — In the beginning the urethra should be injected 
by a fountain syringe with a saturated solution of boric acid, every 
morning and evening for two or three weeks. If there be no im- 
provement, nitrate of silver may be used instead of the acid, from 
one to two grains to the ounce of water, injected in the same 
way. Where inflammation in the urethra is very intense it is 
sometimes better to use a solution of subnitrate of bismuth, one 
dram to the ounce of distilled water. It coats the irritated parts 
and has a very soothing effect. It should be used after urination. 
Sulphate of zinc and golden seal may be used when the inflam- 
mation is not so great. 

Constitutionally. — During the first three or four weeks ben- 
zoate of soda, five grains every four hours, should be given. It is an 
antiseptic and keeps the bladder, kidneys and urethra antiseptic. 



698 VENEREAL DISEASES. 

Formerly balsam of copevia was used in teaspoonful doses three 
times a day. It is a valuable remedy, but sometimes overstimu- 
lates the kidneys and produces a rash upon the skin which alarms 
the patient. Strictures are best relieved by dilators. The diet 
should be light and unstimulating, and quiet rest in bed is im- 
portant during the period of most active inflammation. The 
treatment for gonorrhea must often be continued faithfully for 
one or two years, and must be varied from time to time as the 
symptoms indicate. Sometimes the removal of testicles, or 
ovaries and Fallopian tubes, is necessary to save life. Place no 
confidence in remedies advertised to "knock it in three days." 
There are comparatively harmless forms of urethral inflammation 
that are easily overcome, but only thorough and persistent treat- 
ment — long and intelligently administered — cures gonorrhea. 

MASTURBATION. 
(Onanism. Self-abuse. Self-pollution.) 

Masturbation (from manus, a hand; stupro, to commit adul- 
tery.) "The excitation of the genital organs by rubbing and titil- 
lating them with the hand, or other instrument ; a horrid vice, pro- 
ductive of the most serious disturbances of the nervous system, 
and derangement of health." — Hoblyn's Med. Dictionary. 

The problem of self-abuse depends upon acuteness of sensibil- 
ity. We find the evil confined principally to youths whose sen- 
sibilities are more or less blunted, so that, from dullness of per- 
ception, possibly from ignorance, they are unable to measure the 
consequences of the habit. 

Sexual desire at first is usually very strong and the passions 
more or less wild and undisciplined, but those of clear under- 
standing will control and correct them. It is only the stupid who, 
informed as to results, will let libidinous thoughts run unchecked 
until the roused passions seek relief through self-abuse. The in- 
tellectual boy or girl, knowing the relations of cause and effect, and 
equipped with fair common sense, will hold these instincts and 
thoughts in abeyance. 

This is easy at first, but sexual passion, like thirst for rum, if 
left uncurbed, becomes a pitiless master and drives its slave 
through weakened organs, wasted vitality and loss of manhood to 
disease, despair and death. 

Could every boy and girl — for either needs the warning as 
much as the other — just advancing into puberty be fully informed 



VENEREAL DISEASES. 699 

as to the loss of self-respect, self-control, ambition and noble pur- 
pose following in the train of self-abuse; also as to the transmis- 
sion and character of venereal diseases, their loathsomeness and 
the disgrace, suffering and terror they entail, and be shown how 
large a part of the insanity in the world is the fruit of improper 
sexual indulgence, it is certain that fewer would be ruined. 

The guardian, more than the child, is to blame for vicious 
habits contracted through ignorance, but their curse to the victim 
is no less damning. Masturbation, lewdness and adultery are in- 
creasing in this country. When will people awake to the gravity 
of this matter? Parents who shrink from a confidential and full 
explanation to their children, at the proper time, of newly de- 
veloping instincts and powers, their purpose, use and abuse, should 
at least place in their hands good books upon the subject that they 
may acquire a correct understanding of these most important 
tendencies and passions affecting character and health, rather than 
leave them to pick up fragmentary knowledge and distorted facts 
from impure companions at school and on the street. 

Masturbation at first produces no change in the genital or- 
gans. In healthy young men there is more or less plethora of 
the seminal vesicles, resulting in occasional emissions or night 
losses. This is the natural condition, but if the sexual impulse be 
indulged too often it not only becomes a ruling passion, but patho- 
logical alterations result, the nervous system is exhausted and 
there is loss of equilibrium in the cells of the spinal center. When 
the nerves which are distributed to the seminal vesicles and the 
prostate are exhausted there is more or less irritability in those 
parts, rendering them liable to congestion and chronic inflamma- 
tion. When these vesicles become supersensitive their normal 
contents, which are semen, cause irritability with ejaculation. This 
soon becomes involuntary and is known as spermatorrhea, which 
is accompanied by a train of ills leading to chronic invalidism, some 
of which are indigestion, constipation, dyspepsia, weak back, 
weakened and irregular action of the heart, enfeebled vision, vari- 
cocele and mental obtuseness. 

Treatment. — The mind must be kept free from unclean 
thoughts. Associate only with those of pure character. En- 
large the mental scope by schools and libraries, or by good litera- 
ture at home and by healthy occupation that will engross the 
thoughts. 

Bathe the genitals with cold water on retiring at night, after 



700 - VENEREAL DISEASES. 

which keep the hands and all other excitants away from these or- 
gans and permit the mind to dwell only upon pure and elevating 
themes. By this treatment and fully controlling the habit the pa- 
tient is restored to perfect health. 

SEMINAL LOSSES. 

From a healthy, vigorous man, though at the time leading a 
continent life, there may be emissions of semen during sleep. 
Great alarm is often experienced by a patient affected in this way, 
and he is frequently made the victim of most shameful imposition 
and fraud by so-called specialists, who, by taking advantage of his 
ignorance and fears, frighten him into such terror as to become an 
easy prey to trickery worse than robbery itself. Although noc- 
turnal emissions usually occur only in those who have sometime 
been guilty of self-abuse or sexual excesses, or are in the habit of 
indulging in impure reveries, or mental unchastity, if the losses oc- 
cur but once in ten or fifteen days they are rather in the nature of 
relief of overdistended organs than cause for alarm. They are 
most frequent at the age of greatest sexual, activity and it is even 
claimed by some physicians that in well-fed persons who take lit- 
tle exercise they may sometimes be conducive to health. 

It is, however, better to be free from them, for there is dan- 
ger in their liability to increase in frequency until they become a 
habit very difficult to overcome, and a serious drain upon the 
system, but not until the losses occur so often as to cause feelings 
of prostration the next day, headache and general dullness, both 
physical and mental, is there need for seeking medical advice. It 
should then be obtained from your family physician, who will 
charge you only a reasonable price and is likely to be far more 
competent to prescribe for you than is the advertising quack, 
whose chief concern will be to frighten you into a course of treat- 
ment that will enable him to secure your purse. 

One who takes vigorous exercise, lives temperately in all 
things, and does not allow his mind to dwell upon sexual 
thoughts, will be very rarely, if at all, troubled in this way. The 
loss usually, but not always, occurs during lascivious dreams. 
Keeping the thoughts pure while awake is the surest way of making 
the dreams pure. The character is the same while dreaming as 
while thinking. It is not only a duty to repress sexual thoughts 
and desires, but a privilege redounding greatly to the health and 
advantage of him who will be governed by this rule. 



VENEREAL DISEASES. 701 

There is a tendency in all the functions of the body to estab- 
lish habits and to act at regular intervals, and nocturnal emissions 
follow the general law. The oftener they occur the oftener they 
are likely to occur, until they become an almost uncontrollable 
habit, destructive alike of body and mind. The secret lies in 
breaking the habit; the sooner the easier and better for the pa- 
tient. 

Treatment. — In healthy men, losses occurring once a week 
can generally be overcome by avoiding hearty food, especially 
hearty suppers, discarding tea, coffee and tobacco, and sleeping 
on a reasonably hard bed, with only a moderate amount of cover- 
ing. It is also a help to take but little drink in the evening, none 
after eight o'clock, and to empty the bladder just before retiring 
and as often through the night as the patient awakes. 

He should rise early, not allowing himself to doze off into 
a second sleep, for it is in this second sleep that the emissions are 
most likely to occur. Acton says : "An early call, or an alarm 
clock, may cure many a patient better than all the medicines in the 
pharmacopeia. It is in early morning, while the bladder is full, 
that the loss takes place. The precaution of keeping the bladder 
empty at night is very important," but we can hardly exaggerate 
the importance of the will and keeping the thoughts pure, for in- 
continence of thought is a most powerful cause of irritation of 
the sexual organs. The mind must be kept clean to effect a 
cure. 

One or two grains of monobromate of camphor, taken at bed- 
time, produces a soothing effect upon the vesicles, causing them to 
retain their contents. From ten to fifteen grains of bromide of 
potassium, taken every four hours through the day, the last dose 
at bed-time, may be used instead of the camphor and is a good 
remedy. Cold sponging of the whole body at bed-time often 
serves a good purpose, but sometimes bathing the genitals in cold 
water does as well. The patient should have abundant exercise 
in the open air, and his diet should consist of easily digestible food. 
When it agrees with the patient, milk is excellent. 

This trouble may also arise from gravel or catarrh of the 
bladder, in which case the remedy lies in the removal of the cause. 
"It may result from too great length and narrowness of the fore- 
skin, making it difficult or impossible to uncover, wash and cleanse 
the glans penis. In this case circumcision, or some other surgical 
operation, is the remedy. 



DISEASES OF THE NERVOUS SYSTEM. 

By~B. D. Eastman, M.D. 

CHAPTER I. 

INANIMATE MACHINERY. 

A complicated, ingenious and successful piece of machinery 
excites everyone to admiration. Take the locomotive, for in- 
stance : Xote its capacity for movement forward or backward ; 
for going at a snail's pace or with the speed of the wind ; for moving 
the lightest car or for hauling a heavily loaded train. How won- 
derful and various its capacities and powers. But after all the 
skill, experience, time and money spent in perfecting and building 
a locomotive, it is, if left to itself, an inert, ineffective, useless 
contrivance. It requires the services of a competent fireman to 
attend to its needs of water and fuel, a skilled engineer to direct, 
control and bring out its powers, and an experienced machinist's 
daily attention to keep it in repair. In short, the locomotive is 
powerless and useless, unless served and controlled by an intelli- 
gence which does not belong to itself and is wholly extraneous and 
foreign to it. 

THE HUMAN MACHINE. 

Compared with a locomotive, the human machine is far more 
delicate, complicated and wonderful. To be sure it cannot exert 
the force of an engine, but, in its range of capabilities, multitude 
of movements, and wonderful adaptation to complicated sur- 
roundings — viewed simply as a machine — it vastly exceeds the 
locomotive, as well as every other mechanical contrivance. But far 
and away, above and beyond the purely mechanical complexity and 
adaptability of the human machine, stands the wonderful, inherent, 
vital principle, by which the various complicated functions and 
processes of the body are controlled and carried on, and through 
which the human machine is rendered self-controlling, self-direct- 
ing and self-repairing. 

703 



704 . DISEASES OF THE NERVOUS SYSTEM. 

THE NERVOUS SYSTEM. 

The different processes and functions of animal life are carried 
on and developed by various organs, to each of which is delegated 
certain duties. Thus, the countless movements of the body de- 
volve upon the muscular system; the preparation of food, to fit it 
to minister to original growth and to repair the waste caused by 
vital action, is the duty of the stomach and other digestive organs ; 
respiration is carried on by the lungs, circulation by the heart, and 
so on; but the highest, most complex and most important duty, 
namely, the regulating, controlling and directing of all the organs 
and functions, is confided to the Nervous System. 

It is the nervous system which marks the distinction between 
the vegetable and animal kingdoms. Vegetable life, in common 
with animal life, is possessed of nutrition, circulation, growth 
and reproduction ; but only animal life is endowed with a nervous 
system, controlling the various functions of the body and placing 
it in conscious communication with the outer world. The lower 
animals possess nervous systems, which, in some special directions, 
may exceed in acuteness the corresponding functions of the human 
organism, but they fall short of the latter in the completeness, per- 
fection and development of their powers as a whole. 

GRAY MATTER AND WHITE MATTER. 

The nervous system, using the term in its widest sense, is 
composed of two varieties of nerve matter, called the gray matter 
and the white matter, each of which has its own functions and a 
structure peculiar to itself. 

The Gray Matter is distinctively cellular in structure — that 
is, it is made up of very minute microscopic bodies called cells, 
which, in the main, are of an irregular, rounded form, with two, 
three, or more, long, slender projections, or processes, as they are 
called, by which they are connected with each other and with the 
nerve fibers. This gray matter, wherever found, has a tendency 
to gather itself into irregular somewhat globular form, and its 
functions are to receive impressions, act upon them and direct the 
activities. 

The White Matter, although developed from cells, appears to 
be made up of long slender fibers, and its office is to carry im- 
pressions to and convey orders from the gray matter. These deli- 
cate fibers penetrate the gray matter and interlace with the 



DISEASES OF THE NERVOUS SYSTEM. 705 

processes of the cells, thereby forming nervous connection with 
them. 

The nervous system, thus constituted, is divided into several 
different parts; namely, the brain, which is contained within the 
skull ; the spinal cord, situated in the spinal canal — the long, bony 
tube formed in the back bone or spinal column ; the bundles of 
nerve fibers which radiate from the brain and cord; the specially 
developed ends of these nerves, called "end organs;'' and certain 
connected nerves and nerve gatherings, called the sympathetic 
system and ganglions. 

It is by means of these "end organs," especially adapted to 
differing requirements, that we have the sense of touch and other 
special senses, that the stomach appreciates the presence of food 
and performs the function of digestion, and that the wants and 
needs of the body generally are made known to the central con- 
trolling power. Furthermore, that which places man far above all 
the brute creation, gives him his standing at the head of all 
earthly creations, and enables him to command so widely and 
successfully the resources of the mineral, vegetable and animal 
kingdoms, is his brain function, mind power, mentality. Mental- 
ity is the highest and most complex of nervous phenomena, and is 
a function of the brain, that part of the nervous system con- 
tained within the skull. 

In the further consideration of this subject it will be conducive 
to convenience and clearness to consider ; 

First. The general anatomy of the whole nervous system, 
and its general functions. 

Second. The functions and diseases of the nerves and nerv- 
ous system (as distinguished from the brain). 

Third. The functions and diseases of the brain itself, as con- 
nected with mere nervous action and, more especially, with mental 
action. 

It will not be practicable to entirely separate these three divi- 
sions. They will unavoidably run into each other to some extent, 
but the classification is natural and desirable. 

CEREBRO-SPINAL AXIS, CRANIAL AND SPINAL NERVES. 

The central portion of the nervous system, consisting of the 
brain and spinal cord, is called the cerebro-spinal axis. At certain 
points along this axis bundles of nerve fibers emerge. Those 

45 



706 DISEASES OF THE NERVOUS SYSTEM. 

which appear to emerge from the brain are called cranial nerves; 
those from the spinal cord, spinal nerves. In general these nerves 
are bundles composed of two kinds of fibers, some nerves being 
of one kind, some of the other, while some are made up of both 
kinds. These two kinds of fibers have different functions. The 
one, which we may call the incoming nerve, is charged with con- 
veying messages (sensations or impulses) from without inward. 
Through these nerves the central nervous organization receives 
impressions from without of pain, touch, heat, cold, location, pres- 
sure, weight, space, sight, hearing, smell and taste. Some only 
awaken latent energy in the spinal centers, and are called excito- 
reflex nerves, a term which will be explained hereafter. 

The other nerve fibers are charged with carrying messages 
from within outward, and are called outgoing nerves. The nerves 
which carry impulses to the muscles are called motor nerves; those 
.which affect the blood vessels, vaso-motor; those which control 
the action of the glands, secretory nerves ; and those which regu- 
late nutrition, trophic nerves. It is through the two kinds of 
nerves, called in general sensory and motor nerves, that man is 
put in appreciative connection and association with his surround- 
ings. 

NERVE TERMINALS. 

The main nerve trunks divide and subdivide until they reach 
all the elements of the parts which they supply, and their terminal 
filaments are fitted for the work they have to do by development 
into "end organs." For instance, the nerves of touch terminate 
in small, rounded bodies, very sensitive to the character of surface 
with which the skin comes in contact ; the nerves of taste are spread 
out on the inside of little sacks opening upon the surface of the 
tongue, into which the articles tested find their way. So, too, 
the motor nerves have their peculiar endings, those going to the 
voluntary muscles terminating in the minute muscular fibers by 
thin, flat enlargements, called end plates. The nerves which go 
to the glands terminate more abruptly; while those to the blood 
vessels, and other involuntary muscular fibers, terminate in minute 
interlacing fibers. The main nerve trunks with their ramifications, 
reaching all the elements of the parts which they supply, are known 
as the peripheral (outside) nerves. 



DISEASES OF THE NERVOUS SYSTEM. 707 

SUBDIVISIONS OF THE BRAIN. 

The important subdivisions of the brain, as far as they need 
be mentioned here, are the cerebrum, meaning great brain; the 
cerebellum, small or hinder brain ; the pons, or bridge ; and the 
oblongata, or oblong body. 

The Cerebrum constitutes nearly seven-eighths of the whole 
brain, and occupies the entire upper part of the brain cavity. From 
the top downward, for about two-thirds of its depth, it is divided 
by a fissure into two parts, which are reversed duplicates of each 
other, called the right and left brain, or right and left hemispheres. 
These two halves are separated by a crescent-shaped membranous 
partition, called the falx, which is attached to the skull above and 
serves to separate the two halves, as well as to protect and to hold 
them in proper place. At the bottom of this fissure the two sides 
of the cerebrum are connected together by a band of nerve fibers 
which serve to connect similar parts of the right and left hemisphere, 
and the front and back portions of each hemisphere. Below this 
connecting band, which from its color is called the corpus callosum 
(white body), fibers from the two hemispheres pass into and 
through two small divisions, the pons and oblongata, which will be 
described later. 

The Cerebellum, situated behind and below the cerebrum, is 
also divided, but less completely, into a right and left lobe, and is 
joined by bands of connecting fibers to the cerebrum, pons and 
oblongata. 

The Poiis and the Oblongata are situated at the base of the 
brain between the cerebrum above, the spinal cord below, and 
the cerebellum behind. The pons (bridge) is a small body, about 
one and a quarter inches from right to left and three-quarters of 
an inch from front to back, and is so called because it appears to 
spring across from side to side, like an arch, over the beginning 
of the oblongata. These two subdivisions serve the very im- 
portant function of joining the cerebrum, cerebellum and spinal 
cord, one with another, by bundles of fibers through which motor, 
sensory, vaso-motor and trophic impulses are sent from the brain 
to the body and from the body to the brain. 

This gathering and distributing function of the pons may be 
illustrated by the working of a telephone exchange. Subscrib- 
ers from different portions of the city desire to be put in com- 
munication with other subscribers; the central office is notified 



708 DISEASES OF THE NERVOUS SYSTEM. 

and suitable connection made at the switchboard, to which all 
the wires converge. The pons, which as part of its function con- 
nects the different parts, has been called the switchboard of the 
brain. 

The passage of all these connecting fibers through the small 
pons and oblongata renders them very important parts of the 
brain structure, and it follows that diseases or injuries (lesions) in 
these organs, by interfering with the transmission of the various 
impulses, cause symptoms of wide extent and very serious nature. 
Moreover, these parts of the brain are not simply organs of 
transmission. They contain centers of very great importance, 
which preside over deglutition, respiration, heart action, and other 
important vital functions, as we shall notice more fully further 
on. 

DECUSSATION OF NERVES 

A remarkable peculiarity in the general arrangement of 
nerve fibers, between the brain and the body, is that the left side 
of the brain is connected to the right side of the body and the 
right side of the brain is connected with the left side of the body. 
This is brought about by a decussation (crossing over) of the lines 
of communication from each side of the brain to the other side of 
the spinal cord. About ten per cent of the nerve fibers form an 
exception to this rule and pass to the same side of the brain and 
cord. 

It follows from this general arrangement that injury or dis- 
ease of the left side of the brain produces paralysis, or other 
nervous disturbance, on the right side of the body, and injury 
or disease in the right side of the brain produces paralysis, etc., 
in the left side of the body. 

The facts and clinical observations upon which this principle 
is founded need not be introduced here. Suffice it to say the 
demonstration is complete and in cases of cerebral hemorrhage 
or brain tumor producing paralysis of one side, the surgeon un- 
hesitatingly operates on the side of the brain opposite the paraly- 
sis. The motor fibers and the sensory fibers cross over in dif- 
ferent ways and at different places. 

MOTOR NERVES. 

The motor fibers, which carry impulses from the cerebrum to 
all parts of the body, cross over, that is about ninety per cent of 



DISEASES OF THE NERVOUS SYSTEM. 709 

them do, from left to right and from right to left, in passing 
through the pons and the oblongata. The crossing of nerves going 
to different parts occurs at different places or at different levels, as 
it is termed. The peculiar routes which the different nerve 
tracts take in passing through and crossing over in these organs 
are important and have a special interest to the neurologist, as 
they enable him to determine the particular location of diseases 
of this region. For instance, the motor fibers from each side 
of the brain which move the muscles of the face, the arm, and the 
leg, in passing through these tracts, cross over in the order named : 
The fibers for the lace first, for the arm lower down, and for the 
leg lowest. Hence a lesion in the upper part of the pons affects 
all these fibers and causes paralysis of the whole opposite side ; 
a lesion in the middle or lower third of the pons causes paralysis 
of the face on the side of the lesion, and of the arm and leg on the 
opposite side. 

SENSORY NERVES. 

As to the sensory fibers, which carry impressions from with- 
out inward — from the general body to the brain — they cross over 
from left to right and from right to left, not in any one small part 
of the cerebro-spinal axis, but along the whole length of the 
spinal cord, hence a lesion extending completely across the cord 
gives rise to loss of sensation and of voluntary motion to all parts 
of the body which are supplied with nerves from that portion of 
the cord below the disease, or injury. If the lesion is limited to 
one lateral half of the cord the sensations of touch, pain, tem- 
perature and tickling are lost on the side of the body opposite 
the disease, while the muscular sense and voluntary motion are 
lost on the same side as the disease. 

SURFACE OF THE BRAIN. 

The surface of the brain is divided by fissures into several 
lobes and is made up of many foldings, called convolutions, which 
if they could be spread out would cover an area twice or thrice 
as large as the apparent surface. This whole outer surface of the 
brain, following all its convolutions, is called the cortex or, on 
account of its color, the gray matter. The essential element of the 
gray matter is a mass of microscopic bodies called nerve cells. 
These cells, making up the cortex, are the active elements in 



710 DISEASES OF THE NERVOUS SYSTEM. 

receiving and recording impressions, in directing voluntary move- 
ments, and in general mental activity. These nerve cells are pecu- 
liar in having two, three or more prolongations, several times 
longer than the diameter of the cells themselves. It is through 
the interlacing of these processes, as they are technically called, 
that sensorial and mental operations are supposed to be carried 
on. Indeed, the essential element of all nerve structure is the 
nerve cell in its modifications. In the gray matter the cells re- 
tain the form of a central body with prolongations, or processes, 
hence the gray matter is sometimes called cellular. 

In the white matter the cells take on such an elongated, min- 
ute, cord-like structure, that it is called nerve fiber. Thus we 
speak of the gray or cellular structure, and of the white or fibrilla 
structure, but the nerve cell is the essential element in both. 

Under this cellular layer of gray matter, which is about one- 
eighth of an inch in thickness, is found the white brain matter, 
made up principally of nerve fibers, which connect the various 
parts of the brain together, and also connect the brain with the 
spinal cord and, through the cranial nerves and spinal nerves, with 
all the organs of the body. These white fibers are the medium 
for conducting nerve impulses to and fro. In passing through 
the oblongata and in the cord they are gathered into certain 
bundles or columns — the motor columns and the sensory columns. 
At the base of the brain there are also several masses of gray 
matter, and an L-shaped mass of gray matter runs through each 
side of the spinal cord, the joining together of the two by their 
short sides giving an H-shape to the whole mass; and gray mat- 
ter is found in small masses, called ganglii in connection with 
nerves of sensation. The office of the white matter or nerve fibers 
is to convey impulses; that of the gray matter to receive the im- 
pulses and interpret or act upon them. 

NERVE TRUNKS. 

The central nervous system is connected to the various or- 
gans and parts of the body by cords of nerve fibers, technically 
called nerves. Part of these principal nerve trunks are in direct 
connection with the brain and are called cranial nerves; and part 
are in direct connection with the spinal cord and are known as 
spinal nerves. 



DISEASES OF THE NERVOUS SYSTEM. 



711 



CRANIAL NERVES. 

There are twelve pairs of cranial nerves which have their 
origin, or brain beginning, in different portions of the inner com- 
plicated structure of the cerebrum, the pons, the oblongata and 
the upper portion of the spinal cord. Some of these nerves are 
exclusively sensory, that is, they convey sensations inward ; some 
are exclusively motor — that is, they convey orders for muscular 
movements outward; and some are mixed — that is, a part of 
the fibers convey messages inward, and a part convey messages 
outward. No fiber ever conveys messages in both directions. 

The pairs of cranial nerves, beginning in front and counting 
backward in the order in which they appear on the under surface 
of the brain, upon either side of and near to the middle line, are 
numbered from one to twelve inclusive, and are also named accord- 
ing to their function or according to their distribution — that is, ac- 
cording to the parts to which they go. As the special functions of 
these nerves are of prime importance in considering their diseases, 
the following table is introduced, giving their number, name, dis- 
tribution and function. 

TABLE OF CRANIAL NERVES. 



NUMBER AND NAME. 

I. Olfactory 
II. Optic. 

III. Motor Oculi Com- 

munis. (General 
eye mover). 

IV. Patheticus. 

V. Trifacial (having 
sensory and motor 
divisions). 
VI. Abducens (to pull 
outward). 
VII. Facial. 
VIII. Auditory. 
IX. Glosso-pharyngeal. 

X. Pneumogastric. 

XI. Spinal accessory. 

XII. Hypoglossal. 



GENERAL DISTRIBUTION. 

General membrane of the nose. 
Retina of the eye. 

Muscles of the eye, except two that 
turn it downward and outward. 

One muscle which rotates the eye 

downward and outward. 
Sensory: Face, forehead, eye, nose, 

ear, mouth, tongue and teeth. 
Motor: Muscles of mastication. 
To outer muscle of the eye. 

Muscles of the ear, face, palate, etc. 
Inner apparatus of the ear. 
Tongue, pharynx (throat), ear, etc. 

Lung, heart, diaphragm, stomach 

and adjoining parts. 
Muscles of the neck, pharynx and 

larynx. 
Muscles of the tongue, etc. 



FUNCTION. 

Sense of smell. 
Sense of light. 
Motor. 



Motor. 

Mixed; mainly 
sensory. 

Motor. 

Motor. 

Sense of hearing. 

Mixed; mainly 

sensory. 
Mixed; mainly 

sensory. 
Mixed; mainly 

motor 
Motor. 



SPINAL NERVES. 
The spinal nerves are those which emanate wholly from the 



spinal cord. 



712 DISEASES OF THE NERVOUS SYSTEM. 

They are practically uniform and regular in their structure 
and arrangement, and occur in pairs, coming out from the cord on 
either side through passages between the bones which form the 
spinal column. Each nerve is made up of two parts; roots, as 
they are called. The root which is furthest back, called the 
posterior root, comes from the sensory columns of the cord and 
has sensory functions only. The one at the front, called the an- 
terior root, comes from the motor columns, and has motor func- 
tions only. They unite before passing out through the inter- 
vertebral opening, and the spinal nerves are therefore mixed, 
having both sensory and motor functions. 

The spinal nerves, not counting rudimentary ones, number 
thirty-one pairs. They are classified and numbered according 
to the divisions of the bony spinal column (vertebra) as follows : 

Cervical nerves, eight (neck). 

Dorsal nerves, twelve (upper back). 

Lumbar nerves, five (small of back). 

Sacral nerves, five (between the hip bones). 

Coccygeal nerves, one (extreme end of the spine). 

The spinal nerves are distributed to the muscles and integu- 
ment (skin) upon a definite plan, all the details of which it is im- 
portant for the physician to understand, because it is by knowing 
just what nerve goes to each part, that disease affecting the cord 
is located. For all present purposes a very general and brief 
consideration of their distribution will suffice. Some of these 
nerves send out their branches with but little intercommunication, 
but others, by a kind of interlacing and crossing, form a network 
of nerve trunks, called a plexus, and from this plexus branches 
are distributed to different parts. The four upper cervical nerves 
form the cervical plexus, from which branches are distributed to 
the muscles and the skin of the back of the head, neck, shoulders, 
etc. Branches from this plexus also unite to form the phrenic 
nerve, which is the principal motor nerve of the diaphragm. The 
great clinical importance of this nerve rests upon the fact that the 
diaphragm, which is the principal muscle of respiration, is im- 
mediately paralyzed by injury to the phrenic nerve, causing im- 
mediate and very dangerous interference with the breathing. 

The fifth, sixth, seventh and eighth cervical nerves and the 
first dorsal nerve, by an interlacing, form the brachial (arm) 



DISEASES OF THE NERVOUS SYSTEM. 713 

plexus, situated under the arm, from which branches go to the 
neck, shoulders, chest and the arm, forearm and hand. These 
two are connected and are sometimes called the cervico-brachial 
plexus. The remainder of the dorsal nerves, except the twelfth, 
send out branches to the muscles and skin of the trunk without 
uniting to such an extent as to form a plexus, but it should be 
stated that, in common with all the spinal nerves, each one con- 
nects to some extent with the nerves above and below. The 
lumbar, sacral and coccygeal nerves unite to form the great lumbo- 
sacral plexus, which distributes branches to the lower portion of 
the body and to the legs. 

CENTERS OF NERVOUS ACTION. 

To a person unfamiliar with the details of operation, a large 
modern union railway station is a most bewildering and confus- 
ing place. Trains constantly come and go, cross from one track 
to another and take different sidings, with no apparent system 
or control. The novice, observing the seeming confusion, is sur- 
prised at the freedom from accidents and wrecks. Upon investiga- 
tion he finds, at some convenient central point, the switch tower, 
from which all these movements are directed, and learns that it is 
equipped with groups of keys or levers, each of which is in con- 
nection, by electricity or compressed air, with a switch or signal, 
so that when its key is operated the switch is thrown or signal 
shown as required. This tower, with its lines of communication 
radiating in every direction, is the central agency through which 
the whole complex system is made obedient, and each of its keys 
may be called the center of control for that part of the system to 
which it is connected. Furthermore, it is easily understood that 
the mechanism may be so arranged that certain movements or 
combinations cannot be made unless preceded by certain other 
movements; and that injury to the central mechanism, or to the 
connecting device controlling any portion, prevents communica- 
tion to that part and renders it inoperative. This crude illustra- 
tion may serve to aid in understanding the centers of the brain 
and spinal cord. 

The word center is very frequently used in connection with 
healthful action of the brain, cord and nerves, and in diseased 
conditions as well. As commonly used, a center is a collection of 
gray and white matter, of nerve cells and nerve fibers, of varying 



714 - DISEASES OF THE NERVOUS SYSTEM. 

size and complexity, having control of some physiological action. 
If one of these centers is destroyed the phenomena which it con- 
trols ceases; if the center is irritated by mechanical, chemical or 
electrical action, the phenomena appear. These centers exist all 
along the cerebro-spinal axis and appertain to all the functions of 
the whole nervous system. They are termed lower or higher, 
accordingly as the phenomena which they control are compara- 
tively simple or complex. 

As to location, they are designated as brain centers and spinal 
centers; as to methods of action, they are volitional when they 
can be set in motion by the will; automatic when they act in- 
dependently of the will ; and reflex when they act in a peculiar 
automatic manner. They are also called sensory, motor, vaso- 
motor and trophic, according to their special action, and certain 
ones, whose integrity is essential to life, are called vital. 

BRAIN CENTERS. 

The brain centers of which we have the most practical 
knowledge are situated on its surface and are. therefore called 
cortical centers. It is but a few years since it was determined that 
certain parts of the brain cortex have direct control over the 
movements of definite groups of muscles. By carefully observing 
and recording the symptoms in cases of impaired power of the 
use of certain groups of muscles, and by studying the evidences 
of brain disease found after death, it was ascertained that a definite 
^relation exists between the two. This discovery has been 
strengthened and extended by experiments performed upon the 
lower animals, and by the results of surgical operations 
upon the human brain. The outcome of all these studies confirms 
the theory that definite circumscribed areas of the brain cortex, 
the cortical centers, have special functions. 

In general the frontal portion of the cerebrum, comprising 
a little less than one-quarter, has control of the higher mental 
operations; the next section, considerably more than one-quarter, 
has control of the voluntary muscles and is called the motor area ; 
the third section, less than one-quarter, is the general sensory 
zone; and the hindermost part contains the centers for vision, etc. 

The motor area, second section, is the one most clearly un- 
derstood, and regarding which our knowledge is the most prac- 
tically useful. In this area the centers for movements of the arm, 



DISEASES OF THE NERVOUS SYSTEM. 715 

leg, hand, foot, thumb, great toe and many other parts have been 
definitely located and mapped. 

Corresponding with the right and left divisions of the brain 
and body, these cortical centers are found on both sides of the 
brain, actuating, of course, the muscles of the opposite side. For 
parts that act separately, as, for instance, the legs, the right and 
left centers act independently, and a lesion of one of them affects 
only the muscles on the opposite side. It is doubtful if under any 
circumstancs the center for one leg ever controls the other. In 
cases where the muscles of the two sides act in concert, as in 
breathing and talking, the centers are intimately connected and, 
in case of injury to one, the other acts for both. In still other in- 
stances, where the function is of a highly elaborated and complex 
character, such as speech, the center on the left side is especially 
developed, and takes precedence in control, the center on 
the right side being held in abeyance. If such centers on the left 
side be injured, the one on the right can probably be educated 
to act as a substitute. 

SPINAL CENTERS. 

The spinal cord may be considered as made up of successive 
segments, one for each pair of spinal nerves. Each of these seg- 
ments may be considered as a special center, giving out nerves 
going" to certain zones or regions. A thorough knowledge of 
such distribution is important to the neurologist, as it enables him 
to determine the location of disease in the cord from the muscles 
and parts involved. 

Along each side of the spinal column runs a chain of nerves 
and ganglia, connected by filaments with the spinal nerves, and 
called the sympathetic nerve, the two chains, with their rami- 
fications, constituting the sympathetic nervous system. It has 
chiefly to do with those functions which are carried on involun- 
tarily, without any effort or will of the person, as the dilatation 
or contraction of the blood vessels in blushing, the processes of 
digestion and nutrition, secretion by glands, etc. 

REFLEX ACTION. 
Very many functions of different organs, as well as move- 
ments of the muscular system, are more or less under the control 
of the cerebro-spinal axis, through what is called reflex action. 



716 DISEASES OF THE NERVOUS SYSTEM. 

Their phenomena are called reflex or, sometimes, the reflexes. 
These reflex phenomena occur in connection with movements 
or functions which ordinarily are under the control of the will, 
are partially under such control, or are always wholly independent 
of the will. The following are examples of reflex action ordinarily 
under the control of the will. A foreign substance touching the 
eyeball, or rapidly approaching it, will cause the eyelids to sud- 
denly close without any voluntary effort. If one leg be thrown 
over the other and allowed to hang loosely, with no muscular 
contraction, and a slight blow be struck upon the tendon just be- 
low the knee-pan, the muscles of the front of the thigh will in- 
voluntarily contract and the foot be thrown forward. This is 
called the "patella reflex." The explanation of this phenomenon 
is as follows: The blow over the tendon sends a message by the 
sensory nerve to the spinal cord, where this message is trans- 
formed from the sensory side to the nerve on the motor side which 
takes it to the muscle as a message or notification to contract. 

In illustration of reflex action affecting functions partially 
under control of the will, the functions of the bowels, the bladder 
and of respiration may be cited. In the young infant the action of 
the bowels and bladder are entirely automatic, and not at all under 
the control of the will. As the brain develops and its power in- 
creases the child is enabled, to some extent, to control these func- 
tions. 

In health the principal functions of the gastro-intestinal 
canal, in the processes of digestion, are carried on wholly auto- 
matically, that is, without any appreciation or control by the in- 
dividual. When, however, the nutriment has all been absorbed 
from the food in its passage through the bowel and a certain 
amount of residuum and excrementitious matter has accumulated 
in the lower part of the bowel, a certain automatic reflex action 
is set up and the individual feels the desire to evacuate the bowels. 

Prompt attention to this "call of nature" facilitates the con- 
tinuation of the automatic action and the bowel will be evacuated 
without any conscious effort. If, however, the will be exercised to 
restrain this action the call can be postponed. 13y continued re- 
petition of this restraint, the reflex susceptibility becomes blunted 
and finally may be almost completely suppressed, resulting in 
chronic torpor of the bowels, a condition which underlies a great 
deal of ill-health. Conversely, if due attention is given to nature's 



DISEASES OF THE NERVOUS SYSTEM. 717 

promptings, a regularity of habit can be acquired which will prove 
very useful. Quite similar in many respects, is the reflex function 
of the bladder. When a certain distention is reached, the sensory 
nerves announce the fact to the spinal cord and demand relief. 
This request can be voluntarily controlled and disobeyed for a 
time, but not as continuously, or harmfully, as with the bowel. 

Another interesting example of partial control is that of res- 
piration, the continuation of which, with but brief interruption, is 
essential to life, being one of the vital processes and under an au- 
tomatic control from a center in the oblongata, whose vigilance, 
waking or sleeping, is always alert; yet the exigencies of speak- 
ing, singing, etc., require a voluntary control now and then of 
this function. We are able, therefore, within very narrow limits, 
to modify the breathing and even to suspend it for a brief period ; 
but in a short time the reflex demand for air in the lungs becomes 
so urgent that the will is forced to give way and breathing is re- 
sumed. It is impossible, therefore, for one to "hold his breath" 
long enough to bring about a fatal issue. 

Reflex action in organs and functions always wholly inde- 
pendent of the will is well illustrated in the heart and circulation. 
The action of the heart is entirely independent of will power, yet 
very susceptible to various reflex influences. Thus muscular ex- 
ertion stimulates the heart to increased activity; and joy, fear, 
fright, physical injury, ingestion of poisons or stimulants, etc., 
produce sudden change in the frequency and force of the heart's 
action. 

Of course, a great deal regarding the anatomy and physiology 
of the brain and nervous system must, here be omitted, there be- 
ing space for only so much as is necessary to a general, non-pro- 
fessional understanding of nervous and mental diseases. 

INVESTING MEMBRANE AND BLOOD VESSELS. 

Two points pertaining to the nervous system require elucida- 
tion before going on with its diseases, to wit : Its investing mem- 
branes and blood vessels. 

The bony cavity which contains the brain is lined with a 
strong, firm, adherent membrane, smooth and glistening on the 
side next the brain, called by the old anatomists, who imagined it 
produced the brain, the dura mater (hard mother). The outer cov- 
ering of the brain itself, called the arachnoid (cob-web-like), is 



718 , DISEASES OF THE NERVOUS SYSTEM. 

a thin, delicate, transparent membrane, through which the con- 
volutions can easily be seen. It comes in contact with the dura, 
but does not adhere to it. Under the arachnoid is another de- 
licate covering, made up principally of very small blood vessels 
which furnish blood to the cortex, to the superficial gray matter 
and to the adjacent white matter. It is called the pia mater 
(tender mother) because of its peculiar office. 

The lower part of the brain is supplied with blood by a dif- 
ferent set of vessels penetrating from below. In general, the ar- 
rangement of the blood vessels of the brain differs from that in 
other parts of the body by not having any provision for anastomo- 
sis (opening into each other). In other parts the small arterial 
branches open into each other, or connect together. Hence, if a 
vessel of considerable size ever becomes obstructed by accident, 
disease or surgical operation, the region which it nourished will 
still be supplied by what is termed collateral circulation ; that is, the 
blood will find its way to the region by the communications with 
other arteries. Thus the hand is supplied by two vessels, one on 
either side, which come together in a loop ; if one becomes ob- 
structed the other supplies the entire loop. Not so in the brain, 
for there the arterioles (small arteries) do not communicate. The 
consequence is that if one of the arterioles becomes obstructed 
the region which it supplied is no longer nourished and speedily 
disintegrates — a very important clinical fact. The investing mem- 
branes of the spinal cord are similar to those of the brain. These 
membranes taken together are called the meninges (coverings). 

HOW NERVES ARE FORMED, 

The conducting part of a nerve fiber is called the axis cylin- 
der, and is a grayish, slender cord. Surrounding this is a fatty 
substance called the medullary sheath. Surrounding the medul- 
lary, and the contained axis cylinder, like a glove finger, is a 
delicate, transparent membrane called, after the name of its dis- 
coverer, the sheath of Schwann. In the brain and spinal cord the 
sheath of Schwann is not found, but it is always present with the 
outside nerves. When the nerves enter the terminal end organs 
the medullary, sheath stops and only the axis cylinder goes on. 
The fibers are gathered into bundles, each of which is surrounded 
by its sheath, and finally these bundles are grouped together and 
covered by an investing membrane. It is this latter collection of 



DISEASES OF THE NERVOUS SYSTEM. 719 

bundles which is usually called a nerve. Both the conducting 
elements of such a nerve and the investing membranes are sub- 
ject to disease; the latter by inflammation, or other causes, may 
become so swollen, or thickened, as to produce destructive pres- 
sure upon the axis cylinder. 



CHAPTER II. 

REGENERATION AND REPAIR. 

As a general rule the processes of regeneration and repair in 
the lower forms of animal life are, comparatively, more complete 
and extensive than in the higher animals. Thus some of the 
simplest of animal organizations, if divided in twain, immediately 
rearrange the parts of either half into two complete and perfect 
organizations. Somewhat higher in the scale, we find a class called 
the crustaceans (covered with a shell-like crust), of which the lob- 
ster, crab and shrimp are examples, having the power of reproduc- 
ing lost parts, as legs or claws. 

In the highest types of animal life, among which man stands 
pre-eminently first, these wholesale methods of repair do not 
exist. The very elaborate and complicated organs of the body 
cannot be reproduced or even repaired as a whole, but repair of 
injury or disease goes on in the microscopic cells which make up 
the widely differentiated structures. We find, too, as might nat- 
urally be expected, that in these higher organizations, with their 
refinements of structure and function, the diseases to which they 
are subject are correspondingly more varied and complicated. 

Furthermore, the nervous system, being the most highly de- 
veloped, is especially liable to both functional and organic de- 
rangement or disease, and the complete restoration of function 
or repair of lesion is not as readily accomplished here as in some 
of the less complicated organs. It follows clearly from the fore- 
going considerations, together with the fact that the nervous sys- 
tem holds such important and controlling powers and functions, 
that the study of its diseases is alike the most important and the 
most difficult of pathological problems. 

Before taking up the diseases of the special nerves, or special 
departments of the nervous system, it is desirable to briefly con- 
sider, in a general way, the different forms of disease to which 
the nervous system is subject. These diseases may be considered 
under a few general heads, as follows: (i) Malformations of 

720 



DISEASES OF THE NERVOUS SYSTEM. 721 

development; (2) Inflammations; (3) Degenerations; (4) Tumors 
and adventitious products; (5) Diseases of the blood vessels; (6) 
Vascular disturbances, and (7) Functional disorders. 

MALFORMATIONS OF DEVELOPMENT. 

The normal development of the nervous system begins very 
soon after the first manifestation of vitality in the ovum and pro- 
ceeds, step by step, until the cerebro-spinal axis and the whole 
nervous system is anatomically perfected, before birth. This nor- 
mal development may, however, be arrested more or less com- 
pletely at almost any stage, or the development may proceed 
along unnatural lines. Such arrested or abnormal development 
gives rise to malformations or monstrosities, which may be so 
comparatively insignificant as not to be demonstrable during life; 
or they may be so extensive as to prohibit independent existence. 
These arrests and deviations of growth and development ordi- 
narily affect both the bodily structure and the mental capacity, 
so that mental deficiency usually accompanies both arrest of de- 
velopment and unnatural excess of growth. This statement is 
clearly substantiated by cases of feeble-mindedness, imbecility 
and idiocy, by dwarfism, gigantism, cretinism, and other similar 
conditions. 

The normal brain, at birth, is structurally perfected, but it 
has not reached its full growth, and arrest of development may 
occur at any time before growth is complete. Practically, such ar- 
rest almost always occurs before the period of adolescence, and 
may consist of an imperfect development of the whole brain or 
of some particular portion of it, or the whole cerebro-spinal axis 
may be abnormally small. Hypertrophy (overgrowth) of the 
brain is rare, and may be total or partial. Sometimes parts of the 
brain may be misplaced, or its natural cavities may be dilated and 
filled with serous fluid, and sometimes the bony brain case may 
be wanting, or it may be so firm and solid as to prevent expansion 
and opportunity of brain growth. 

INFLAMMATION. 

When living tissue is irritated, the process or state which 
is set up, or which follows, is called inflammation. The general 
symptoms of inflammation, pain, heat, redness and swelling, are 
apparent to persons inexperienced in medicine. But some of 

46 



722 ' DISEASES OF THE NERVOUS SYSTEM. 

the most important results of inflammation are not readily ap- 
parent, or easily understood, by a superficial observer. Any por- 
tion of the nervous system, or of the structures which envelop it, 
may be attacked by inflammation. This disease, primarily con- 
fined to the blood vessels and similar structures, may attack the 
nervous tissues, either quickly or slowly. The attack may be 
upon the nerve elements' themselves, or upon the connective 
tissues, which surround, cover or separate the nerve elements 
proper, or it may attack both. It may pass away without seri- 
ously impairing the nerve structure or its functions, or it may lead 
to degeneration and total loss of function. It is often of infectious 
or toxic origin. In common with inflammation of other struc- 
tures, inflammation of nervous tissue may result in an exudation, 
or pouring out from the blood vessels of an unnatural material, 
called an exudate. This exudate may be serous, a clear yellow- 
ish fluid; fibrous, a soft, solid, adherent mass; or purulent, having 
the well-known appearance of pus or "matter"' as seen in an 
abscess or boil. These conditions may or may not be ac- 
companied by the death of the tissue affected. Such exudate 
may make its way into the substance of the brain, spinal cord 
or nerves, with, of course, very damaging results. 

Inflammatory action may be limited to a small place or 
spot, it may be found in many spots (multiple), or it may spread 
over a large area, as the entire surface of the brain. It may be 
caused by syphilis, when new tissue may be slowly formed by 
excessive cell growth, called proliferation, without any exudation. 
Inflammation of nerve tissue may be acute, subacute, or chronic — 
that is, of a violent, rapid movement; a less rapid, moderate 
movement ; or an especially slow, insidious movement. 

Meningitis. — When the membranes covering the brain or 
spinal cord are inflamed the disease is called meningitis, which is 
usually included among the diseases of the nervous system, be- 
cause its most important and serious symptoms appertain to the 
nervous system, through the close connection and relation of 
the membranes (meninges) and the nervous structure. There 
are several varieties of meningitis, depending upon the particular 
region and parts involved, the special causes of the inflammation, 
or the character of the exudate. 



DISEASES OF THE NERVOUS SYSTEM. 723 

DEGENERATIONS. 

Under certain conditions nerve cells and fibers are subject 
to a gradual process of decay and death, called degeneration. 
In other conditions, as, for instance, arrest of blood supply by 
occlusion of a blood vessel, the process of softening and death, 
or necrosis, may be rapid and is termed acute degeneration. 
The principal varieties of degeneration are the granular or fatty, 
when the nerve cells lose their proper character and become 
granular or fatty; pigmentary, when they become filled with 
abnormal coloring matter; fibroid, when a fibrous tissue takes the 
place of the nerve element ; and calcareous, when the cells become 
changed into a chalky matter. 

Degenerations may also be primary or secondary. In pri- 
mary degeneration the bodies of the cells gradually grow smaller, 
and irregular in shape, and their processes dwindle or disappear. 
This form may be caused by arrest of development in the early or 
embryonic stage; or it may be caused by infections or poisons. 
Secondary degeneration follows hemorrhage into the brain, tumor 
pressing upon both the nerve structure and the vessels which 
nourish it, abscess, injury to the brain or spinal cord, etc., all 
being conditions which interfere with the proper nutrition of the 
nerve tissue by cutting off blood supply, by pressure, by direct 
injury, by disease, etc. Degeneration of the central nervous 
system may also result from disordered blood, or from disease of 
the blood vessels, which interferes with the proper supply of 
blood, either condition causing imperfect nutrition. 

When degeneration of the nerve cells is complete or, in other 
words, when their nerve character is destroyed, they cannot be 
replaced, and such parts of the nervous system will always re- 
main useless. But when they have been only damaged, regenera- 
tion may take place even after a long time. The capacity for such 
restoration is greater in the peripheral (outside) nerves than in 
the central portions. The nerves going to the extremities some- 
times recover their functions after long periods of impairment, 
but brain structure less readily recuperates. 

Another form of degeneration is called sclerosis, a term de- 
rived from a Greek word meaning hard. In sclerosis the con- 
nective tissue which forms the delicate coverings of the nerve 
fibers and bundles becomes thickened and hardened, presses upon 
the true nerve structure, and interferes with its nutrition, so that it 
becomes unable to properly perform its functions. 



724 DISEASES OE THE NERVOUS SYSTEM. 

This interference with the function of the motor nerves 
causes various semi-paralytic disorders and, if the sensory nerves 
are affected, causes impaired and deranged sensation. A similar 
condition may occur in the brain, causing an incurable form of 
insanity. 

Senility. — The natural condition of the nervous system in 
old age is that of slow decay. The general nerve tissue becomes 
shrunken, brain function becomes impaired, the power of the 
nerves to conduct impressions is lessened and the blood vessels 
nourishing nerve structure deteriorate. These are simply parts 
of the general deterioration of the whole system during the period 
of natural decline. These changes sometimes occur much earlier 
in life than usual, constituting premature senility. Indeed, senil- 
ity is not marked by years, but by the changes in the brain. 
Sometimes this senile degeneration is so much exaggerated, either 
generally or in special localities, as to be properly classed as 
disease. 

TUMORS AND ADVENTITIOUS PRODUCTS. 

Various tumors, tuberculous, cancerous, syphilitic, etc., may 
develop in the brain and spinal cord. Occasionally the eggs of 
certain parasites find their way into the brain through the cir- 
culation, then develop into one phase of their cycle of growth, 
called hydatids, which appear like cysts filled with transparent 
fluid. Other cysts are sometimes found rilled with a watery fluid, 
or with blood, and abscesses are not infrequent. 

These foreign growths, or bodies, damage the nerve tissue 
by pressure, by interference with nutrition, or by destroying it, 
and are likely, sooner or later, to cause death. Incidentally, it 
may be said that some of these growths can be cured by medicine, 
some can be removed by surgery, while others, from their location, 
extent or character, are incurable and necessarily fatal. 

VASCULAR DISTURBANCES. 

The brain is one of the most vascular organs of the body, re- 
ceiving a much larger proportional supply of blood than most 
other parts. The vessels of the brain are also thinner and have 
less resistance than the vessels in the body generally, hence the 
brain is especially liable to hemorrhage from giving way of the 
blood vessels. These hemorrhages may be very small but 



DISEASES OF THE NERVOUS SYSTEM. 725 

numerous and repeated, causing thickening and change of struc- 
ture of the meninges, or degenerations of the brain itself. When 
the vessels themselves have become diseased or weakened by bad 
habits, or old age, one of considerable size may give way, the out- 
pouring blood rending the brain structure, or compressing it like 
a foreign body, or both. On the other hand, disease of the vessels 
may lessen or even occlude their caliber, or clots, etc., may ob- 
struct them, leading to softening and death of parts of the 
brain by cutting off blood supply. Compression and concussion 
may also produce softening. 

Too great an amount of blood in the brain (congestion or 
hyperemia) may be caused by excitement, fever and alcohol or 
other toxic agents; and may be followed by serious results. On 
the other hand the brain may suffer from anemia (lack of blood) 
because of a general anemic condition of the whole body, or from 
hemorrhage, or from local diseases, or from contractions in blood 
vessels. 

FUNCTIONAL DISEASES. 

This term means diseases not due to change of structure, but 
to mode of action. The so-called functional diseases of the brain 
(and of other organs as well) are growing less and less as our 
means of investigation become more perfect and complete, and 
enable us to determine changes of structure formerly unknown. 

PREDISPOSING CAUSES. 

Of these one of the most potent is heredity. Heredity may be 
either direct or potential. Imbecile parents may have imbecile chil- 
dren, or there maybe a marked family tendency to the development, 
at about the same period of life, of similar forms of brain disease. 
Heredity is therefore active in the embryonic and fetal states (con- 
ditions before birth) and potential later, being most likely to as- 
sert itself in the developmental and critical periods of life. Hys- 
teria, neurasthenia (nerve exhaustion), mania, melancholia, etc., 
are very likely to occur in families, alternating with alcoholism, 
epilepsy, syphilis, tuberculosis, etc. Insanity, deafmutism, pau- 
perism, criminality, etc., not infrequently show themselves as in- 
heritances from remote ancestors. Age, sex, race, occupation, 
habits, social condition, poisons and infections constitute other 
predisposing causes of nervous diseases. 



726 DISEASES OF THE NERVOUS SYSTEM. 

EXCITING CAUSES. 

Some of the foregoing may act as exciting causes, as do 
emotion, fright, mental strain, reflex irritation (irritation of the 
central nervous system by local diseases or conditions), injury, 
shock, etc. The mental causes, as a rule, produce functional de- 
rangements, but they may cause such intense congestion as to 
lead to organic disease, or even to fatal hemorrhage. 

DEVELOPMENTAL INFLUENCES. 

These are of great importance. In the embryonic and fetal 
periods they result in arrest or aberration, giving rise to mal- 
formations, idiocy and imbecility. During the stage of rapid 
brain growth, from infancy to about the seventh year, untoward 
tendencies may be shown by convulsions, night terrors, brief 
delirium, ephemeral fever, meningitis, etc. Chorea, epilepsy and 
family types are likely to appear during the second period of 
seven years; while hysteria, epilepsy, insanity, sexual perversions, 
etc., develop during puberty and youth. 

No one can live to himself alone. The individual develops 
from, and is dominated by, a long line of ancestors, and, in turn, 
transmits dominating tendencies to posterity. He may be likened 
to the trunk of a tree, which receives support, development and 
possibilities from its wide spreading roots and passes on its char- 
acteristics and tendencies through its seeds. 

In infancy and early childhood the nerve centers are unstable 
and irritable, hence the presence of spasms, brief but high fever, 
chorea, and the like, often being reflex disturbances from teething, 
indigestion, etc. In puberty and youth, when both the physical 
and mental characteristics are being determined, come the marked 
family tendencies. Later, under the burdens of business, family 
cares, various excesses, severe mental strain, etc., the functional 
neuroses appear, and finally, in old age, degeneration and hemor- 
rhagic disturbances bring about senility and paralysis of different 
forms. 

The female is more subject to hysteria, neurasthenia, head- 
ache, spineache and neuralgia. The motor paralyses are more 
frequent in the male, largely owing to the exposure incident to 
occupation. Many occupations, as those of clerks, telegraphers, 
typewriters, musicians and teachers, cause special forms of nervous 
disease. Paralyses, neuralgias and neurites may be caused by 



DISEASES OF THE NERVOUS SYSTEM. 727 

mineral poisons, such as lead, mercury and arsenic. Eye strain 
may cause disabling headaches. Even idleness may lead to 
hypochondria. 

HABITS AND SOCIAL CONDITION. 

Alcohol causes special types of nervous disease, often of the 
most serious character. It is especially detrimental to the young 
before full bodily development has taken place, and the same is 
true of tobacco. Sexual irregularities and abuses depress both 
the physical and the psychical powers, producing functional neuro- 
ses, disorders which may terminate in organic diseases; but the 
popular idea that insanity, in either sex, is almost always due to 
the sexual apparatus is an error. Vicious habits of thought and 
action, bad educational methods, the harassments of a high and 
exacting society, the mental strain of the struggle for wealth and 
position, as well as the wear and tear of poverty, unceasing toil, 
unhappy domestic relations, improvidence, the monotony of the 
farm and the alley, all tend to prematurely break down the nerv- 
ous system. Microbic agencies, imperfect excretion of poisons 
normally formed in the body, infectious processes, syphilitic poi- 
son, self-infection and self-intoxication by poisonous substances, 
generated within the system because of the transgression of 
nature's laws of health, are still other causes of disease of the 
nervous system, upon which space does not permit further com- 
ment. 



CHAPTER III. 

NEURALGIA. 

Neuralgia means a nerve pain. It is a disorder of the sensory 
fibers of the nerves, distributed to different parts of the body, 
and called peripheral nerves. In some cases the motor fibers be- 
come involved, owing to their close association with the sensory 
fibers. Neuralgia is classed as a functional disease, because we 
are unable to determine, by any method at our command, that 
there is any change of structure in the painful nerve ; but it is very 
probable that changes of structure may some time be demon- 
strated. 

The term neuralgia is often misapplied, and it is important, 
therefore, to explain more fully the exact difference between ordi- 
nary pain and nerve pain or neuralgia. Ordinary pain is the 
nerve expression of local diseased conditions. Take, for instance, 
a case of injury to the hand, or of a felon on the finger. The 
ultimate nerve filaments of sensation are compressed by the 
swelling and irritated by the presence of inflammatory products. 
These impressions of irritation are conducted to the brain and 
are there translated into sensations of pain, which are referred to 
or appear to come from the injured hand or the diseased finger, 
and we say the hand or the finger is painful. 

As an illustration of a neuralgia, or nerve pain, may be cited 
the pain which a person who has suffered an amputation may feel 
in the lost member. The popular idea is that when such pain is 
felt, it is an indication that the amputated member has been buried 
in a cramped position, or is being "cut up by the doctors," and 
that disinterment or rescue and - careful re-burial in a natural 
position will relieve the pain. It goes without saying that to a 
clear-headed, non-superstitious person, this notion is absurd, but 
the explanation of feeling pain in an amputated member is not 
so clear. 

The fact is that persons often do feel pain in amputated mem- 
bers, or rather they feel pain which is referred to such lost 

728 



DISEASES OF THE NERVOUS SYSTEM. 729 

parts. The philosophy of this may be compared to the annuncia- 
tor of a hotel. Each room is connected to it by electric wires. 
When the proper pressure or contact is made in a room, the an- 
nunciator records the number thereof ; but if the wires be cut any- 
where between the room and the annunciator, and the cut ends 
be brought in contact, the annunciator bell will ring and the 
number of the room will be indicated. In a somewhat similar 
manner the different parts of the body are connected, by means 
of nerve fibers, with the brain. Local irritation of the end organs 
of these nerves is transmitted to the brain, which locates the 
sensation in the part affected. If, now, a limb be amputated and 
the nerve fibers which connected the lost limb with the brain be 
irritated in the stump, this irritation will be conveyed to the brain, 
where it will be translated into sensation, which will seem to come 
from and be referred to the missing member. The person, there- 
fore, really feels exactly the same sensation as if the limb were in its 
proper place ; in fact, he actually feels his amputated toes or fingers. 
It is very evident that the condition of the amputated limb has 
nothing whatever to do with this sensation. It depends entirely 
upon that part of the nerve fibers which remain in connection with 
the brain. The sensation referred to in the lost member is a neu- 
ralgia or nerve pain. 

Returning to the general consideration of neuralgia, the pain 
varies from a mild ache to a severe pain, and may run through the 
whole possible scale of variety — boring, grinding, dragging, stab- 
bing, burning, etc. The pain of neuralgia has peculiarities which 
distinguish it from pain due to organic disease, namely, it often 
shifts from one nerve, or set of nerves, to another, and has certain 
points of tenderness along the affected nerve. 

Neuralgia may affect any nerve in the body, but only the 
most important will be considered. 

NEURALGIA OF THE HEAD. 

The important neuralgia of the head is that of the fifth pair 
of cranial nerves. This nerve is of mixed function, being both 
sensory and motor, and the largest of the cranial nerves. It is 
the great sensory nerve of the face, forehead and upper part of the 
scalp to back of and including the ears. It divides into three 
main branches, the ophthalmic, which goes to the eye, brow, scalp, 
etc., the superior maxillary, which goes to the cheek, nose, upper 



730 DISEASES OF THE NERVOUS SYSTEM. 

teeth, etc., and the inferior maxillary, which goes to the lower part 
of the face, the under teeth, tongue, etc. It also supplies nerves 
of sensation to the interior of the nose, mouth and throat. Fila- 
ments from the different branches interlace freely, but each nerve 
is strictly confined to its own side of the face. The motor part of 
this nerve is in the third or inferior maxillary division, and is dis- 
tributed to the muscles of mastication. 

The very large number of nerve filaments in the face and ad- 
jacent parts (among the most sensitive portions of the body) 
cause any irritant to any part of this nerve to produce a profound 
impression. Pieces of glass, or other foreign substances, lodged 
in the face, the irritation of decayed teeth, etc., sometimes cause 
the most fearful neuralgic pains, and even set up paralyses, tremor 
and epilepsy. There is a peculiar association of action in the 
nerves, both between the different branches upon the same side, 
and also between the two opposite nerves. Thus irritation of the 
inferior maxillary branch, from decayed teeth, may cause in- 
flammation of the eye on the same side, earache, inflammation of 
the middle ear, etc. This nerve is sometimes called the sentry, 
because its different branches at the orifice of the eye, nose, 
mouth and ear stand guard to give warning of approach. In- 
flammation and disorganization of one eye from injury is very 
likely to set up a similar process in the other. Upon the first in- 
dication of such sympathetic inflammation the only proper pro- 
cedure is removal of the diseased eye. 

Ordinary simple neuralgia may be manifested in any or all 
the branches of this nerve, ranging from mild to very severe. 
There is also a special form of neuralgia of this nerve, called 
tic douloureux, in which the pains come with the most intense 
severity, often accompanied by spasms, and driving the sufferer 
well nigh distracted. 

The back of the head and neck is subject to neuralgia affect- 
ing the four upper spinal nerves, called cervico-occipital. The 
lower and front part of the chest and region of the ribs are 
respectively subject to neuralgias of the phrenic nerve (an im- 
portant respiratory nerve) and the sensory branches of the dorsal 
spinal nerves. Neuralgia of the lumbar nerves may be referred 
to the small of the back, the lower part of the abdomen, the front 
and inner part of the thigh, the front of the knee joint, the inner 
part of the leg and of the foot. 



DISEASES OF THE NERVOUS SYSTEM. 731 

In the upper extremities, neuralgia of the brachial plexus 
affects different parts of the arm and hand. The chief neuralgia 
of the lower extremities is known as sciatica, or pain in the great 
sciatic nerve, which passes into the leg a little behind the head 
of the femur or bone of the thigh. 

This is often an excruciatingly painful neuralgia. The in- 
ternal organs are not free from neuralgic pains. In mild cases 
only the sensory parts of the nerves are affected, but all parts of 
the nerves may be affected, and there may be sensory, motor and 
sympathetic disturbances. 

Causes. — The causes of neuralgia are many, among them 
heredity, gout, neurasthenia, anemia, malaria, eye-strain, decayed 
teeth, injury, influenza, changes of temperature, poisons, syphiiis, 
hysteria, etc. The hereditary causation of neuralgia cannot be 
disputed, but a clear distinction should be made between those 
who have had occasional attacks, from efficient causes, and those 
who are constantly neuralgic. Probably no one escapes an at- 
tack some time during life. 

Neurasthenia and anemia act as causes by virtue of lowered 
vitality ; malaria by a similar condition, dependent upon the mala- 
rial poison in the blood ; eye-strain, injury and decayed teeth 
act by direct strain or irritation of branches of the nerve ; in- 
fluenza, poisons and syphilis, by poisonous and depressing action 
on the nerves ; changes of temperature, by impairing nerve re- 
sistance. Many neuralgic cases are intimately connected with 
barometric disturbances. Some are affected on the approach of 
a storm, and can foretell its coming; others are most affected during 
the presence of the storm ; and still others during the clear, bright 
weather following it. 

There are many other diseases which may be mistaken for 
neuralgia, such as tumor of the brain or spine, disease of the 
bones of the spinal column, inflammation of the nerves, etc., and 
in all cases of neuralgic pain the patient should receive, in the 
early stages, competent medical advice. 

The majority of cases make good recoveries; but much 
depends upon the kind of neuralgia and the cause. If the cause 
is one which cannot be removed, either by medical treatment or 
surgery, cure cannot be expected. 

Neuralgia of the fifth nerve (one of the most common va- 
rieties) is generally curable, except when in the severer spasmodic 
form, called tic douloureux. 



732 DISEASES OF THE NERVOUS SYSTEM. 

Treatment. — In a disorder of so varied causation, so likely 
to be serious and assuming so many forms, home treatment is in- 
expedient and the best medical advice attainable should be sought 
without delay. The first thing the physician will consider is whether 
the neuralgia is due to some general bodily ailment, anemia for 
instance, which weakens the whole system, or to some local irri- 
tation, as defective teeth. He will look for the local irritation 
first, remove it, if possible, and then, if the neuralgia persists, use 
measures to bring vitality up to the plane of health. 

This is often a tedious and difficult task and will tax the 
resources of the ablest physician. If there be anemia sufficient 
to cause neuralgia it must be treated rigorously, with rest in bed, 
feeding and the best of nerve tonics. In gouty (rheumatic or li- 
themic) neuralgia, treatment must be directed to the constitutional 
disorders underlying these conditions. 

When neuralgia can be clearly traced to malarial poisoning, 
the scientific use of quinine will prove curative. Five years ago, 
the writer cured a severe case of facial neuralgia, due to malaria, 
with three doses of quinine, and there has been no return. 

In many cases remedies must be used to relieve the pain 
while the cause is being removed and the general health improved. 
A warm and equable temperature often relieves neuralgic pains 
and serves as an important aid to other remedies. A towel folded 
into many thicknesses, wrung out of water nearly boiling hot, then 
clapped upon the back of the neck and held there, will sometimes 
afford quick relief in cases of facial neuralgia, as well as in those 
affecting the back of the head. Electricity, properly applied, is 
often of great value, especially in the form affecting the back of 
the head. When the intercostal nerves are affected remedies 
to relieve pain, galvanization of the spinal cord, local support, 
liniments, rest in bed and quinine with salicylate of soda are the 
best means of treatment. For neuralgias of the arm, similar 
remedies with rest for the limb in a soft sling. 

Neuralgias of the lower extremities, principally sciatica, are 
less satisfactory to treat because of the greater difficulty of putting 
the part at rest. To secure good results the patient must be kept 
in bed, or at least on a couch, for four to twelve weeks, and 
such remedies used as the case demands. In very obstinate cases 
of neuralgia which have resisted all medical treatment, especially 
in tic douloureux, or where there is pressure upon a nerve, it is 



DISEASES OF THE NERVOUS SYSTEM. 733 

often advisable to resort to surgical procedure for relief, such 
as the stretching of the nerve, or the resection, or cutting out of a 
portion of the nerve. Such means usually give relief for a time, 
but the pain is apt to recur. A case in which several surgical 
operations had been performed on the fifth nerve, without material 
improvement, was completely cured, under the direction of the 
writer, by galvanism. Incidentally, it may be stated that in neu- 
ralgia of the maxillary branches of the fifth nerve, in which the 
pain is referred to sound teeth, the extraction of such teeth will not 
relieve the malady. 

It is often the case that the physician can give such directions 
as to diet and mode of life as will have a strong influence in 
lessening the frequency and severity of attacks, even if they can- 
not be altogether prevented. The very best treatment for neu- 
ralgia is preventive. Careful attention to the laws of hygiene and 
keeping up sound health will keep this malady far away. 

NEURITIS. 

Neuritis is an inflammatory affection of a nerve trunk, nerve 
branches, or nerve filaments, causing one or more of the follow- 
ing symptoms : Pain, impaired sensation, motor paralysis and 
atrophy. There are two forms : The simple, affecting a single 
nerve; and the multiple, affecting different nerve trunks or fila- 
ments, often in an apparently capricious manner, and frequently 
symmetrical on the two sides. Simple neuritis may be caused by 
injury, such as contused or lacerated wounds ; by pressure upon the 
brachial plexus, as by sleeping with the arm thrown over the back 
of a chair; by jar, as of railroad accident; by exposure to cold, by 
gout, syphilis, cancer, typhoid fever, diphtheria and other general 
diseases; by extension of inflammation from pneumonia, pleurisy, 
meningitis, articular rheumatism, etc. 

Symptoms. — The symptoms of neuritis vary in different 
cases, according to the function of the nerve affected. There is 
always pain, more or less paralysis when a motor nerve is affected, 
impaired sensation when a sensory nerve is attacked ; as, for in- 
stance, neuritis of the optic nerve impairs and may destroy vision ; 
of the auditory nerve may cause deafness, or false hearing of loud 
noises; while neuritis of the general sensory nerves produces de- 
rangement of general sensation. The first symptom is generally 
pain more or less severe in the nerve itself, frequently intermittent. 



734 DISEASES OF THE NERVOUS SYSTEM. 

This is likely to rapidly become very severe. Impairment of 
movement, as a "rule, comes on quickly, followed by atrophy or 
shrinking of the diseased muscles. There is also impairment of 
sensation ; the sense of touch may be blunted or entirely lost ; sen- 
sation of pain may be diminished or wholly lost in the part sup- 
plied by the nerve; trophic changes, that is changes in nutrition, 
take place and the skin becomes glossy, parchment-like ; perspira- 
tion may be increased or diminished, and electrical stimulation may 
show degeneration. 

Neuritis may be acute (active and of rapid progress), subacute 
(less active and slower) or chronic (moderate and long continued). 
The essential condition in neuritis is the disorganization of the 
axis-cylinder — that part of the nerve that is necessary to the 
transmitting of impulses. It has a natural tendency to recover, 
varies much in its duration, and can be greatly modified and bene- 
fited by proper treatment. 

In neuritis from injury much depends upon the character of 
the injury. 

Treatment. — If a large nerve be cleanly cut across, the ends 
should be brought together by surgical operation, with expecta- 
tion that function will be restored; if imprisoned in the callus 
thrown out by a broken bone, or in the swelling of an inflamed 
joint, such pressure must be removed, by surgical or natural pro- 
cess, and the part put at rest, before improvement can take place. 

The line of treatment must be varied as required. In case of 
the arm it should be carried in a sling, and assistance be had in 
dressing and undressing. In neuritis of the trunk, riding or walk- 
ing should be prohibited, and the movements of the trunk les- 
sened by supports, or rest in bed. If the disease be in the lower 
extremities, rest in bed should be the first consideration, and be 
rigidly enforced, and the use of the legs be restricted, even through 
convalescence, until recovery is well assured. Pain must be con- 
trolled, proper reconstructives be used if the general health is poor, 
and special remedies employed which have a favorable effect 
upon the diseased nerve tissue. Electricity, properly applied, is 
of great benefit in many cases, but should only be used under 
competent medical advice. It goes without saying that the most 
careful attention should be given to the general health of the 
patient, to the end that nature may be enabled to put forth its best 
efforts, for in this, as in every disease, the real cure must come 



DISEASES OF THE NERVOUS SYSTEM. 735 

through vital action, to which the physician can render most effi- 
cient aid, but without which he can do nothing. 

MULTIPLE NEURITIS. 

In this form different nerve trunks or filaments throughout 
the body or extremities are affected, sometimes in a capricious 
manner, and sometimes symmetrically; that is, corresponding 
nerves on opposite sides are affected simultaneously. Multiple 
neuritis may be caused by poisonous agents, such as alcohol, lead, 
arsenic, etc. These agents may produce very serious effects upon 
all parts of the nervous system, but in many cases their influence 
is most pernicious on the peripheral nerves. 

Most cases of "alcoholic paralysis," "lead palsy," etc., are 
due to multiple neuritis. This disease may also be caused by in- 
fectious agents, or poisons developed within the body in diph- 
theria, typhoid fever, malaria, tuberculosis, etc. In the course of 
these diseases, or later, multiple neuritis may be developed. In 
tropical countries a peculiar form of multiple neuritis is often epi- 
demic, due, probably, to an infectious micro-organism. Expo- 
sure to cold and dampness and overexertion are also causative 
of this disorder. It is more common in females than in males. 
Diphtheritic cases occur mostly in childhood ; other cases appear 
at all ages after puberty. 

Symptoms. — Multiple neuritis presents a wide variety of 
symptoms. Those connected with sensation are the first to 
attract attention and the last to pass away. In most cases numb- 
ness, tingling or formication (a feeling as if ants were crawling on 
the skin) are first noticed. Generally these sensations begin in 
the feet and hands and extend to the knees and elbows, or some- 
times beyond. There may also be very distressing burning, 
stretching, boring or tearing sensations. Pain is generally pre- 
sent, usualh' moderate and not continuous, sometimes sharp, lan- 
cinating and very severe. 

Tenderness of nerves and muscles is always present, some- 
times so great as to prevent handling or moving the limb. Along 
with this painful feeling there is disturbance of normal sensation. 
At first there is oversensitiveness to touch ; later diminished 
sensibility. In some cases the patient can feel that something is 
touching his limb, but cannot tell where. The special senses are 
not often affected. 



736 DISEASES OF THE NERVOUS SYSTEM. 

The motor symptoms are as marked and important as the sen- 
sory. In the beginning there is a sense of simple weakness or 
fatigue which gradually increases until paralysis is complete, or 
sometimes the paralysis is developed rapidly in a few days. This 
paralysis may begin in a single muscle and gradually include 
others, and it may begin in one extremity and extend to all, 
or otherwise. As a rule it is most severe in the muscles which 
move the hands and wrists and the feet and ankles. Occasion- 
ally it attacks the thighs and arms, rarely the muscles of the trunk, 
but when these are attacked respiration is suspended and death 
follows. 

The paralyzed muscles are relaxed, flabby and wasted, and 
the limbs assume abnormal positions, of which the "wrist drop" 
of "lead palsy" is a common example. In this form of multiple 
neuritis, when the patient attempts to hold out his hand, with 
palms downward, they drop or hang downward at the wrist 
and he is unable to raise them. 

There are certain types of this disease which may well 
be mentioned. If a person accustomed to use alcoholic liquors 
in excess complains of muscular weakness, suddenly becomes 
paralyzed in arms and legs, has fever, becomes delirious, shows 
great tenderness of limbs, etc., the case is doubtless alcoholic multi- 
ple neuritis. If one who has been exposed to contamination by 
arsenic complains of numbness, tingling, clumsiness and fatigue, 
shows inability to properly control the muscles of the hands 
and feet, with tenderness along nerves and weak muscles, it is 
multiple neuritis from arsenic. Similar conditions, with marked 
weakness of the extensor muscles of the forearm, causing "wrist 
drop," indicate the same disease from lead poisoning. 

A good proportion of cases of multiple neuritis recover. 
Very severe cases caused by alcohol, and the infectious forms, 
as found in the tropics, are not likely to recover. Cases have 
been known to be restored in three months, others have required 
two years to complete a cure. 

Treatment. — Inasmuch as most cases are toxic in origin, 
the first indication for treatment is to remove the cause. In 
alcoholic cases, that poison must be abandoned, and resumption 
of its use after recovery is likely to cause relapse. Lead and 
arsenic must be eliminated from the system by suitable medicines. 
In diphtheria and other causative diseases, hygienic and anti- 



DISEASES OE THE XERl'OUS SYSTEM. 787 

septic measures must be employed to counteract infectious influ- 
ences. General supporting treatments full, nutritious diet abound- 
ing in fat, reconstructive tonics and nerve stimulants, frequentlv 
changed, are advantageous. The scientific use of hot and cold 
douches, of the various electrical currents, and of skilled massage 
after tenderness has subsided, are of great benefit. At first rest 
must be had ; later, moderate exercise, not carried to fatigue. 

FACIAL PARALYSIS. 

A comparatively common and very interesting example of 
neuritis in a peripheral nerve is that known as Facial Paralysis, 
or Bell's Palsy. 

This is an inflammation of the seventh cranial nerve, or 
facial nerve, which has exclusively motor functions, and is dis- 
tributed to the muscles of the middle ear, the face, the palate, 
etc. This paralysis is usually easy of recognition, as it attacks 
but one side of the face, as a rule, and the resulting change of 
expression is very characteristic. 

Facial paralysis may be preceded by a sense of fullness or 
puffiness of the face, or it may come on suddenly without pre- 
monitory symptoms, and the whole side of the face be at- 
tacked within three or four hours. Sometimes a person, going 
to bed well, may find one side of his face completely paralyzed 
in the morning. The characteristic appearance of the face in 
this disease is caused by the paralysis of the muscles on the 
affected side, and the normal tonicity and voluntary contraction 
on the sound side. 

On the affected side the eyebrow is elevated, the lids unnat- 
urally separated, the lower lid drooping and allowing overflow 
of tears ; the patient is unable to wink or close the lid, even 
in sleep, which may cause irritation and inflammation, and the 
lines of expression on that side are lost. The mouth is drawn 
to the sound side by the unopposed action of the muscles of 
that side. The lips on the affected side cannot be brought 
together, hence whistling is impossible, and, upon attempting 
it. the cheek bellies out uselessly. On account of the paralysis 
of the cheek, mastication is not naturally performed-- the food 
accumulating between the teeth and the cheek. If the disease 
extends along the nerve toward its origin sufficiently far, the 
branches which go to the muscles of the palate are involved, 
and their paralysis embarrasses speaking and swallowing. 

47 



738 DISEASES OF THE NERVOUS SYSTEM. 

The causes of facial paralysis are many, some of which 
operate upon the nerve directly, others affecting it through central 
lesions. In its exit from the cranial cavity, the facial nerve 
passes through a long bony canal, wherein slight swelling of 
its investing membrane, or slight effusion therein, will produce 
serious pressure upon it, and, as it emerges from this canal a 
little below the opening into the ear, its exposed situation ren- 
ders it particularly liable to injury from violence or exposure 
to cold. Hence ; the most frequent cause is exposure to wind 
or draught from an open door or window, especially a car window. 
Among other causes is a general rheumatic condition ; disease 
of the middle ear, which operates by extension of the inflamma- 
tion to the closely adjacent nerve; injury, as a blow upon the 
ear; diphtheria, scarlet fever, etc., and lesions of the brain in 
connection with the origin of the nerve, or parts intimately con- 
nected therewith. 

The outcome of facial paralysis varies widely, according to 
the cause and the special location of the lesion. Simple uncom- 
plicated causes from exposure to cold recover, as a rule, in two 
or three months, but cases due to central brain lesions are very 
unfavorable. 

Treatment. — The treatment must depend largely upon the 
cause. A superficial neuritis from exposure, etc., will require 
the treatment indicated for neuritis generally. If there be disease 
of the middle ear, such disease must have prompt, efficient at- 
tention. Rheumatic cases require anti-rheumatic treatment. If 
it depends upon brain lesion, the outlook is serious and the treat- 
ment must be mainly directed to the brain, although local treat- 
ment will still be of service and should not be neglected. 



CHAPTER IV. 

DISEASES OF THE SPINAL CORD AND OBLONGATA. 

Certain anatomical and physiological arrangements of the 
spinal cord have such intimate bearing upon its diseases, and the 
consequences resulting therefrom, that it is important to bring 
them to mind. The motor and sensory fibers of the cord are 
arranged in separate bundles, or columns, as they are called, 
so that there are motor columns and sensory columns. It may 
be said, with sufficient accuracy for our purpose, that the motor 
columns occupy the anterior or front part of the cord, and 
the sensory columns the posterior or back part. It has already 
been stated in describing the spinal nerves that they consist of 
a motor or anterior root and a sensory or posterior root, being 
mixed nerves, and that the nerves from the upper part of the 
cord go to the upper part of the body and upper extremities, 
the nerves from the midde portion go to the middle of the 
trunk, and those from the lower part to the lower portion of the 
bcdy and the lower extremities. Tracing the motor nerves 
from without into the cord, they spread out and pass through 
the front and side columns of the cord and enter the front 
portions (anterior horns) of H-shaped gray matter which is in 
the anterior of the cord. In this gray matter these fibers, called 
roots, make connection with the motor fibers from the brain, 
which have also passed into the anterior horn. The motor 
impulse from the brain, therefore, follows the motor fibers, which, 
it will be remembered, nearly all cross over in the oblongata, 
then pass down the anterior motor columns of the cord and 
successively penetrate to the anterior horn of gray matter. 
Here the impulse is transmitted to the roots of the motor nerves 
and thence to the muscular fibers. 

The sensory portion of the spinal nerves, constituting the 
posterior roots, enter the cord at the back, pass almost entirely 
and directly into the posterior sensory columns and then cross 
over to the opposite side, by which they go on to the brain. 

739 



740 DISEASES OF THE NERVOUS SYSTEM. 

The spinal cord is, therefore, the main channel of communica- 
tion between the brain and all parts of the body supplied by 
spinal nerves, both as to motor and sensory impulses. Hence, 
it follows that disease of the cord at any point sufficient to inter- 
rupt all its functions will produce paralysis both of motion and 
of sensation in all parts of the body which receive their nerves from 
the spinal cord below the injury. If the disease affects one lateral 
half of the cord there will be motor paralysis upon the side of 
the injury, and sensory paralysis on the side opposite the injury. 
If only certain parts or columns are diseased, the resulting phe- 
nomena will depend upon the function of the diseased portions. 

Of the oblongata it need only be said that all the connecting 
fibers from the brain to the cord pass through it, the motor 
fibers crossing over therein, and that several important cranial 
nerves have their origin in it. Any considerable interference with 
the functions of the oblongata and upper part of the spinal 
cord is incompatible with life, and incapacity of the spinal cord 
to convey nerve impressions paralyzes those parts of the body 
to which the spinal nerves involved are distributed. Inasmuch 
as the nerves which control the so-called "vital functions" of 
respiration and circulation originate in or pass through the 
oblongata and beginning of the cord, the reason why marked 
disease or injury of this part of the cerebro-spinal axis is so 
fatal to life is apparent. Extensive disease of the cerebrum 
and cerebellum may exist without serious disturbance of res- 
piration, circulation or digestion. Disease or injury of the spinal 
cord produces more or less complete paralysis of the parts 
supplied by nerves given off by the cord below the point of 
injury, but if such disease or injury be below that part of the 
cord directly connected with the vital functions, life may continue 
a long time. 

The diseases of the oblongata and spinal cord as recog- 
nized, studied and classified in medical works are numerous 
and of the greatest importance. They are brought about by 
a great variety of causes, are often very difficult of diagnosis 
and their treatment may tax the resources of the best equipped 
specialist. It is not practical in a work intended for the general 
reader to consider these diseases in detail. They will therefore 
be but briefly mentioned, grouped when possible, and only gen- 
eral outlines of treatment indicated, to the end that the reader 



DISEASES OE THE NERVOUS SYSTEM. 741 

may be led to appreciate their importance and induced to con- 
sult a neurologist whenever any of the symptoms mentioned 
are observed. 

MYELITIS OR TRANSVERSE INFLAMMATION OF THE CORD. 

AY hen a portion of the cord is attacked by inflammation, 
which extends to all the columns and divisions, it is called 
myelitis, softening of the cord, transverse myelitis, or inflam- 
mation of the cord. AYhen only a part of the columns are 
implicated, a specific name is used indicating the part affected. 

[Myelitis may be acute, subacute or chronic in its onset. 
AA'hen acute there may be high temperature and rapid pulse, but 
seldom convulsions except in children. 

Symptoms. — -The symptoms will vary widely according to 
the part of the spinal cord involved, but in all cases they group 
into four divisions, namely: Alotor, sensory, rectal and vesical. 
At first these symptoms are of an irritative character, passing 
more or less rapidly and completely into the destructive. AA'hen 
this stage is fully set up there is complete motor and sensory 
paralysis extending upward to the line of the nerve distribution 
involved, with paralysis of the rectum and bladder. Usually 
there is a feeling about the abdomen or chest of a constricting 
band, which indicates the main focus of the disease, just above 
which is a zone of unnatural sensitiveness marking the irritated 
portion of the cord just above the focus. The most frequent 
cause of myelitis is exposure to cold and storms, injury by vio- 
lence or muscular strain, infectious diseases, blood poisoning 
from disease or introduced poisons, spinal meningitis, etc. 

Inflammation of the spinal cord, when acute, is usually 
fatal; speedily so if it involves the upper portion. Subacute and 
chronic cases, under favorable circumstances, sometimes make 
fairly good recoveries, but at best the disease is serious, dis- 
abling and likely to leave impairment behind. 

Treatment. — The proper treatment can only be conducted 
by an able physician; but the efforts of the physician must be 
supplemented by the very best nursing and general care, often 
for a long time. In acute cases absolute rest, general measures 
to check inflammation, and putting the patient on an air or 
water bed to prevent, if possible, the formation of bed sores, 
which are very liable to complicate the case, are some of the 



742 . DISEASES OF THE NERVOUS SYSTEM. 

essential points in care-taking. Chronic cases also require rest, 
less pronounced, to be sure, to which general care, change of 
scene, medicinal springs, etc., always within the limit of fatigue, 
may be added if practicable. 

INFANTILE SPINAL PARALYSIS. 

This form of spinal disease occurs most frequently in young 
children, especially during the period of first dentition. It is 
the most common form of paralysis to which children are sub- 
ject and is easily recognized. 

It may come on with suddenness and violence, acute ; it may 
less violently and rapidly develop, subacute ; or it may slowly 
and gradually make its appearance without active symptoms. In 
the most acute cases a healthy child, either with or without a 
preliminary fever, loses completely or partially the use of one 
or more extremities. Such loss may be sudden, the child going 
to bed apparently well and found in the morning paralyzed, 
or two to four days may be required to develop complete 
paralysis. 

Convulsions sometimes accompany the onset of the paraly- 
sis, but sensibility is never lost ; it is always only motor paralysis. 
As a rule but one limb is affected, the leg about twice as often 
as the arm. Occasionally both legs are paralyzed, more espe- 
cially in the adult, and in a very few cases one arm and one leg 
have been involved. In subacute cases the attack comes on 
Avith little or no force and progresses more slowly, the paralysis 
requiring from two to four weeks for complete development. 
Chronic cases move still more slowly. 

Any of the voluntary muscles of the limbs or trunk may 
be affected, but the functions of the rectum and bladder are 
not impaired. After a few days the paralyzed muscles begin 
to regain their power. Such recovery may be almost complete 
and but few muscles remain permanently impaired, or nearly 
all the muscles originally affected may remain paralyzed; but 
complete recovery in all the muscles affected by infantile paralysis 
never takes place. All the muscles which remain paralyzed ulti- 
mately become atrophied and degenerated. The growth of the 
bones of the affected part is also retarded, with the result that 
the affected limb becomes shorter and smaller than its fellow, 
as well as deformed, because of the unopposed action of the 
healthy muscles. 



DISEASES OF THE NERVOUS SYSTEM. 743 

The real underlying disease in this form of paralysis is 
inflammation and degeneration of the anterior horns or projec- 
tions of the H-shaped gray matter of the cord, these horns 
being, as has already been described, the tract in which the 
motor fibers from the brain connect with the motor fibers 
from the cord to the muscles. Disintegration of this tract, there- 
fore, prevents motor impulses being sent from the brain to the 
muscles, which become withered or atrophied and degenerated, 
because of disuse, and also because of deprivation of that nervous 
influence which controls, guides and stimulates nutrition. 

The cause of this disease of the spinal cord is not clearly 
established. It is by far the most frequent form of paralysis to 
which children are subject, and in its acute form is peculiar 
to childhood, affecting the sexes equally, and generally occurring 
within the first three years of life ; rarely after the sixth year, 
and has been known to attack an infant twelve days old. It is 
found all over the civilized world, often attacks strong, healthy 
children, although most observers find a majority of cases in 
those who are weak and delicate. In many cases other members 
of the same family are affected with some nervous disturbance. 

Among the apparent causes of the acute form in childhood 
are exposure to cold and dampness, injury by fall, etc., disorders 
following such acute diseases as measles, scarlet fever, cerebro- 
spinal meningitis, etc. Not infrequently parents ascribe this 
disease to "a fever," when in fact the fever only marks the 
inflammatory invasion of the cord, and is a consequence rather 
than a cause of the disorder. There is no doubt that the strain 
upon the nervous system during the period of first dentition 
brings about a state of irritability shown by restlessness, disturbed 
nutrition, sleeplessness, etc., in which the spinal cord is unusually 
sensitive, and in which slight active causes, as cold, may pro- 
voke the next step in the process of inflammation. The chronic 
form is seen in adults, usually between the eighteenth and 
fortieth years. In adults, males are most affected, and injury, 
muscular or mental strain, syphilis, dissipation and sexual excess 
are prominent causes. 

In cases ushered in by fever or convulsions it is impossible 
to decide that one has to do with this disease until the paralysis 
has occurred. Hence, the fever, convulsions, etc., must be 
treated upon general principles and endeavor made to lessen 



744 . DISEASES OF THE NERVOUS SYSTEM. 

the fever and control the convulsions or other reflex disturbances. 
As soon as the paralysis makes its appearance the physician 
can determine the nature of the disease and begin a rational 
treatment. 

Counter-irritation to' the region of the spine, or to the 
whole surface, purgatives to lessen congestion of the cord, etc., 
are advantageous. 

For the inflammation of the cord and the degenerations 
thereby set up, but little can be done, but suitable medication 
may be of great benefit in preventing extension of the inflamma- 
tion and in restoring to their proper function those parts of 
the cord which are congested and unnaturally irritable on account 
of proximity to the inflamed portion. Dry cups to the spine 
at the seat of the lesion will be useful in this direction. 

Electricity properly applied to the paralyzed muscles is a 
very effective agent in keeping up their nutrition and integrity 
until the cord resumes its functions. Under its long-continued 
use muscles which at first seemed to have hopelessly lost their 
power may be restored. , 

The deformities which result from infantile spinal paralysis 
are varied and often incapacitating. While these cannot be 
cured, a good deal can be done to mitigate them. Mechanical 
appliances will sometimes enable sound muscles to supply, in 
part, the movements of the disabled ones. 

Massage, especially mechanical massage, will aid in restoring 
nutrition and function to disabled muscles, and tenotomy (divid- 
ing the tendon) will relieve some contractions and sometimes 
restore mobility to joints; all of which must be undertaken only 
under competent medical direction. 

There are a number of diseases of the spinal cord and 
oblongata which, although not very common, are of serious 
importance to the patient and of great interest to the physician. 
They are too complicated and too difficult of comprehension to 
warrant a detailed description for the general reader, and they 
will therefore receive only brief mention. 

ACUTE ASCENDING PARALYSIS. 

This is a form of paralysis, almost wholly motor, commenc- 
ing, in the legs, ascending successively to the trunk, the arms, 
and lastly to the neck and face. Most cases terminate fatally 



DISEASES OF THE NERVOUS SYSTEM. 745 

in from two or three clays to two or three weeks, because exten- 
sion of the disease to the oblongata causes death by involving 
the vital centers of respiration, circulation and deglutition. 

This disease attacks males more frequently than females 
and occurs chiefly between the ages of twenty and forty years. 
It appears to have been caused by severe exposure to cold, or 
to have followed small-pox, diphtheria, typhoid fever, or some 
other obscure febrile disease. Not infrequently the sufferers have 
been subject to chronic alcoholism. It is very probable that the 
immediate factor in the nerve disturbance is some hitherto 
unrecognized toxic agent. While the outlook, especially in 
rapidly moving cases, is extremely bad, recoveries have some- 
times taken place from conditions apparently hopeless. 

SPINAL HEMORRHAGE. 

Extravasations of blood sometimes occur into the spinal 
canal, rarely into the cord itself. Such hemorrhage may happen at 
any age, the most frequent cause being injury, which may have 
produced fracture of the backbone and laceration of vessels, or 
which may have been only a severe jar. 

Spinal hemorrhage may also be brought on by prolonged 
and severe muscular exertion, as, for instance, a typical case 
which occurred in a man who had just won an eight-day, go-as- 
you-please walk. It may also occur in the course of certain hem- 
orrhagic diseases, as purpura, small-pox, yellow fever and typhoid 
fever. 

The prominent symptoms arise from the pressure upon the 
cord and consequent impairment of functions, and consist of 
sudden and violent pain in the back and along the nerves in- 
volved in the pressure, various abnormal sensations, muscular 
spasms, etc., followed by paralysis of the parts supplied by nerves 
below the hemorrhage. The cerebral functions are not usually 
implicated. Spinal hemorrhage is a very dangerous disease and 
may prove fatal in a few hours. - In cases from injury, and some 
others, when a satisfactory diagnosis can be made and the patient 
is strong enough, a surgical operation is warranted. In slowly 
developing cases rest, remedies to divert the blood to other parts 
and wet cupping of the back are indicated. If the patient sur- 
vive long enough, inflammation of the cord below the 



746 DISEASES OE TEIE NERVOUS SYSTEM. 

hemorrhage will be set up and the treatment will be the same as for 
myelitis. 

PROGRESSIVE MUSCULAR ATROPHY OR WASTING PALSY. 

This is a disease characterized by a chronic progressive 
atrophy (wasting away) of the muscles, accompanied by motor 
paralysis, the atrophy and paralysis being almost always exactly 
proportionate. Symmetrical bilateral muscles are often attacked; 
sometimes muscles widely separated are attacked one after an- 
other. This disease presents several varieties or types, as the 
hand type, in which the atrophy generally begins in the muscles 
of the thumb and little finger and progresses to the muscles 
of the hand, producing the so-called "claw hand," in which 
the fingers are drawn and bent somewhat like claws. After a 
long time, years perhaps, the atrophy extends to the forearm 
and upper arm; ultimately the muscles of the shoulder become 
involved, and sometimes those of the tongue, of deglutition and 
of respiration, which may lead to inanition and disturbances in 
the breathing which may prove fatal. 

There are two forms seen especially in the young, the one 
attacking almost always the muscles of the shoulder and upper 
arm first, and extending therefrom; the other beginning in the 
muscles of expression of the face; lastly, there is a form attacking 
the muscles of the leg and foot. 

This disease is of a slow character, running from five to 
thirty years. The changes in the muscles depend upon a slow 
degeneration in the anterior horn of the H-shaped gray matter 
of the cord — the part of the cord whence the motor nerves arise — 
which leads to degeneration of the motor nerves and consequent 
atrophy of the muscles. The two forms especially seen in the 
young are very largely hereditary, extending sometimes through 
several generations. The hand and leg types are not often hered- 
itary, but frequently depend upon muscular strain, prolonged 
exposure to cold, etc., as in mechanics who use the right arm 
excessively and men working in refrigerators and handling ice. 

Progressive muscular atrophy is seldom seen among the 
wealthier classes, except in the hereditary form, the other forms 
being practically limited to the working classes, on account of 
the greater use of muscles and greater exposure.. Acute dis- 
eases are sometimes followed by progressive muscular atrophy. 



DISEASES OF THE NERVOUS SYSTEM. 747 

The adult form is more common in men than in women. An 
unfavorable outcome may be expected in this disease. It is 
important, therefore, that in the beginning of any condition 
suggesting this malady a careful diagnosis be made. For reliev- 
ing the patient's condition and delaying the progress of the dis- 
ease, electricity., massage, rest, cod-liver oil, nerve stimulants 
and a generous diet, in short, means to keep up the nutrition 
and tone of the nerves should be employed. 

LOCOMOTOR ATAXIA. 

The most common of the chronic diseases of the spinal cord 
is generally called locomotor ataxia, which, freely translated, 
means inability to walk. This inability does not depend upon 
atrophy or weakness of the muscles, but upon inability to 
properly combine their action so as to produce a desired result, 
and this is what is meant by ataxia. Motor ataxia is the form 
affecting the movements of the extremities. In static ataxia the 
patient is unable to maintain a steady, upright position of the 
body when sitting, but continually sways from side to side ; 
the difficulty in both cases being of the same nature, but affecting 
different muscles. In attempting to walk the patient makes 
unnatural, jerky, uncertain movements, his legs flop about, and 
he may be entirely unable to walk, or even to stand, although 
his legs cannot be flexed or extended by the strongest man. 
The disease is also called tabes dorsalis, which means "wasting 
of the back," and is sometimes known as ''consumption of the 
spinal cord." 

The principal causes of locomotor ataxia are syphilis, injury, 
alcoholism, other spinal diseases, chronic poisoning by ergot (seen 
only in foreign rye-eating countries) and chronic poisoning by 
arsenic. In addition to the ataxia, both motor and static, the 
patient is affected with pains of a most violent, stabbing, lan- 
cinating character, which come and go suddenly and irregularly, 
and which are not confined to any one particular spot. There 
is also a peculiar condition of the eye, due to atrophy of the 
optic nerve, also sudden violent pains in the stomach, larynx, 
or over the kidneys, liable to last some hours, and simulating 
diseases of the organs of those regions. The functions of the 
bladder are frequently deranged, sometimes early in the disease, 
and the patient may be aware only of bladder trouble. Changes 



748 , DISEASES OF THE NERVOUS SYSTEM. 

in nutrition occur, the bones may become brittle and break 
under any slight provocation ; the joints become impaired and 
movement may be either limited or too free, as in the knees, 
which in attempting to stand may bend the wrong way, almost 
as much as they bend the right way in normal walking. 

There are also other symptoms, not peculiar to this disease, 
as zones of lessened sensibility, retardation of pain conduction 
shown by pricking the patient with a pin, which he feels only 
after several seconds, a feeling as of a girdle encircling the body, 
etc. This disease is essentially chronic in nearly all cases and 
may extend over many years. Occasionally an acute case will 
run its course in a few months. 

It is not practical to go much into details as to the funda- 
mental lesion or disorder of locomotor ataxia. It need only be 
said that it is a degeneration of the spinal cord, and that other 
parts of the nervous system are more or less involved. 

To the skilled neurologist the diagnosis of clearly cut cases 
of this disease is not difficult, but in irregular cases and those 
complicated with other disorders it may be very difficult, for a 
time at least, to determine the real condition. Locomotor ataxia 
is a very incurable disease ; indeed, the best authorities claim 
that the degeneration of the cord, upon which it depends, is 
never cured, but there is no doubt that in many cases the prog- 
ress of the disease can be arrested and the patient relieved of a 
great deal of suffering and in many ways made much more com- 
fortable. To this end anti-syphilitic treatment should be used 
in cases in which syphilis is a factor; galvanism, warmth and 
suspension are useful, together with remedies which directly 
affect the cord and nerves. The food should be light, but nutri- 
tious and easily digested; peptonized, if need be. The patient 
should avoid mental work, anxiety and bodily fatigue. In severe 
acute cases rest in bed for a few weeks is often useful ; in the more 
chronic forms exercise need not be_entirely suspended, but should 
always stop short of fatigue. Exposure to cold is injurious and 
winter is best spent in a warm, dry climate. The patient should 
have the best general surroundings practicable. 

TRAUMATIC AFFECTION OF THE CORD. 

The spinal cord is liable to direct injuries and also to be 
implicated in injuries to the vertebral column — the bony case in 



DISEASES OF THE NERVOUS SYSTEM. 749 

which it is suspended. Direct injuries to the cord may result 
from concussion, as from a fall, railway jar or other violence 
not sufficient to fracture the \ r ertebra. Such injuries may result 
in hemorrhage into or around the cord ; the substance of the 
cord may be lacerated, causing inflammation and softening, or 
the jar to the cord may interfere with its functions without evi- 
dence of actual gross lesion. In fracture or dislocation of the 
vertebral column it is scarcely possible for the cord to escape 
damage, which may vary from very slight to such severe injury 
as to produce complete paralysis below the damaged part, or if 
the injury be in the very upper part of the cord death may follow 
at once. 

The symptoms of traumatic myelitis may not occur imme- 
diately after the injury, but come on gradually; still the symp- 
toms are those of more or less acute myelitis, depending in detail 
upon the location of the injury. 

The cord is also liable to be affected in chronic diseases 
of the bony canal, as Pott's disease, which is, essentially, disor- 
ganization of some of the vertebral bones, causing shortening 
and sharp bends in the column, which may lead to pressure upon 
the cord, etc. 

If fracture of the vertebral column be of such a character 
as to indicate clearly that the spinal cord has been severed, noth- 
ing will restore its functions; if the fracture produce such com- 
pression as to endanger the integrity of the cord, surgical inter- 
ference at once is required ; if there be little or no compression 
general treatment should be given at first; surgery may be 
needed later. 

It may not be amiss to remind the reader that the danger 
to life of a fracture or dislocation of the back or neck depends 
upon the injury done the spinal cord. Many persons have lived 
a long time, some of them in fairly comfortable health, with a 
broken back or neck ; others have lived years with the whole 
lower part of the body paralyzed, while in other cases death is 
instantaneous. 

There are several other diseases of the spinal cord which 
are very important and of great interest to the neurologist, but 
which are so complicated in symptoms as to render it scarcely 
practicable to give them extended notice in a popular work. 
They will, therefore, receive but brief mention. 



750 . DISEASES OF THE NERVOUS SYSTEM. 

SPINAL SCLEROSIS. 

The motor portions of the spinal cord are liable to a peculiar 
degeneration called sclerosis, which consists essentially of a hard- 
ening of the nerve bundles and a degeneration of the axis cylinder 
of the nerve fibers, which impair and finally destroy its functions. 

The symptoms of spinal sclerosis differ according to the 
particular portion of the cord affected; but in general, sclerosis 
is characterized by a permanent contraction of the muscles, some- 
times so marked as to disfigure the limbs, and sometimes only 
so much as to produce a peculiar spasmodic gait in which the 
patient scarcely touches his heel to the ground, but w r alks upon 
his toes and the ball of the foot, as if upon stiff springs, with a char- 
acteristic jerky, jiggery motion. In some forms the functions 
of the bladder are involved, in others not. Generally there are 
neither cerebral, sensory nor rectal symptoms. Sometimes there 
is muscular atrophy, with contraction, which gives rise to ''claw 
hand," etc. All the forms of sclerosis are slow moving, chronic 
in character and hopeless as to cure, although by proper treat- 
ment, good nursing and favorable surroundings the fatal issue 
may be long delayed. The duration may be said to extend 
from three to fifty years. 

BULBAR PARALYSIS. 

Sometimes the oblongata is affected with a degeneration of 
its motor cells, which especially affects the motor cranial nerves 
which spring from this region and are distributed to the tongue, 
lips, larynx, etc. The impairment of function of the implicated 
nerves leads to a difficulty in articulation, especially in pro- 
nouncing words containing letters which require delicate co-or- 
dinate movements of the tongue and lips. Indeed, it is gener- 
ally this interference with articulation which first attracts the 
patient's attention. The paralysis increases, the palate becomes 
affected and finally the voice is much enfeebled by reason of 
paralysis of the muscles of the larynx. Mastication, deglutition, 
respiration and heart action become involved with the progress 
of the disease. The lower part of the face loses its expression 
and the tongue becomes atrophied. The original causes which 
lead to this degeneration of the oblongata — progressive bulbar 
paralysis (the upper part of the cord and the oblongata are some- 
times called the bulb) — are not certainly known. The disease 



DISEASES OF THE NERVOUS SYSTEM. 751 

is essentially a progressive and fatal one, and although some 
times there will be remissions and the symptoms apparently be 
at a standstill, ultimately death ensues by interference with the 
vital functions of respiration and circulation, as well as of nutri- 
tion. Only palliative treatment is available, such as rest, care, 
skillfully prepared food and a few drugs which seem to produce 
a temporary benefit. 

PSEUDO HYPERTROPHIC MUSCULAR PARALYSIS. 

A peculiar neuro-muscular disease called pseudo (false) hyper- 
trophic muscular paralysis is so called because of the great in- 
crease in size of the legs, occasionally the arms also, accom- 
panied by paralysis, but without mental, sensory, rectal, vesical 
or atrophic symptoms. This disease generally commences in 
childhood, most usually occurs in males, and is hereditary. The 
first symptom is weakness of the legs; the child has difficulty in 
walking, the legs are braced apart, the gait becomes waddling, 
the difficulties in walking increase till the child becomes helpless, 
although the legs are unnaturally large. The immediate cause 
of this condition is increase of the connective tissue between 
the muscular fibers — which gives the exaggerated size — the mus- 
cular fibers disappear and are replaced by fatty matter, and 
there is also degeneration of the nerve elements and of the spinal 
.cord. No case of this disease has ever been known to be cured, 
and treatment, thus far at least, has been of no curative avail; 
so our efforts are limited to care and nursing. 

INTRA-CRANIAL HEMORRHAGE, EMBOLISM AND 
THROMBOSIS. 

These three derangements of the circulation within the cra- 
nium give rise to similar cerebral symptoms and will be con- 
sidered together. By intracranial hemorrhage is meant the 
giving way of a blood vessel and the pouring out of blood 
into the brain substance or into one of its cavities, or upon 
its surface. Embolism is the obstruction of a small blood vessel 
by a blood clot formed elsewhere, as on the valves of the heart 
in heart disease, or by some other foreign matter, in either case 
swept on to its resting-place by the blood current. Thrombosis 
is the obstruction of a blood vessel by coagulation of the blood 
therein. 



752 DISEASES OF THE NERVOUS SYSTEM. 

Hemorrhage is the most common. The brain is very vascu- 
lar and receives a proportionally large amount of blood. Its smaller 
vessels are very delicate and it is especially liable to hemorrhage, 
especially after middle age, when the vessels are liable to become 
weakened. Intracranial hemorrhage may also occur in various 
diseases which lead to changes in the blood ; as pyemia (blood 
poisoning from pus), typhoid fever, etc. Heredity is an im- 
portant factor on account of the tendency which exists in some 
families to arterial disease. It was formerly thought that a person 
with a short neck, broad chest and florid complexion was par- 
ticularly liable to cerebral hemorrhage, but it is clear that persons 
of the exactly opposite type are equally liable. The use of alco- 
holic drinks is a strongly predisposing cause, by producing dis- 
ease of the vessels. 

There are two classes of symptoms which attend each of 
the three disorders, cerebral hemorrhage, embolism and thrombo- 
sis : The reflex and the localizing. The reflex symptoms are 
those due to the shock which the cerebrum as a whole sustains. 
The localizing symptoms vary according to the location of the 
disease. The reflex symptoms are loss of consciousness, or coma, 
mental disturbances, convulsions and alterations of temperature, 
and will be more or less marked according to the rapidity of 
the hemorrhage or the amount of brain involved. Loss of 
consciousness may come suddenly without warning, and be com- 
plete, in which case the attack is called apoplexy, or it may be 
preceded by confusion, difficulty of speech, drowsiness, nausea, 
etc., and come on slowly and gradually. In the comatose state 
the face is usually swollen and flushed, or sometimes pale and 
clammy, the eyes fixed, pupils dilated and sluggish, respiration 
slow and noisy, with the cheeks puffing out, pulse slow and 
full, and the limbs useless. Convulsions frequently occur and 
may extend to all parts or be limited to one side, which is after- 
wards found to be paralyzed. The localizing symptoms vary 
according to the precise location of the disease, but as consid- 
erable knowledge pertaining to the nerves is required to under- 
stand them they will not be enumerated. 

Cerebral hemorrhage may be of such extent and involve such 
important structure as to lead to death, either immediately or 
within a few days, without return to consciousness, or the pa- 
tient may recover from the shock and nearly regain his former 



DISEASES OF THE NERVOUS SYSTEM. 753 

vigor; but as a rule there is left more or less paralysis, contraction 
and mental impairment. It is not always possible to distinguish 
between these three varieties of cerebral disease. In all cases with 
symptoms of cerebral hemorrhage, embolism or thrombosis the 
services of the physician should be sought at once. 

The patient should be kept quiet in bed, and not allowed to 
rise up, until all the reflex symptoms have disappeared. In the 
violent, apoplectic form of attack, active cathartics are useful by 
lessening blood pressure and thereby aiding to check the escape 
of blood from the ruptured vessel. Indeed, in many cases, bleed- 
ing would be very advantageous for its immediate effect in ar- 
resting the hemorrhage, but so great is the prejudice against it 
that it has almost wholly fallen into disuse. If the hemorrhage 
ceases, and the patient begins to improve, remedies to aid in the 
absorption of the blood clot and to lessen nervous irritability will 
be useful. The diet should be simple and moderate, and all the 
bodily functions be kept in the best order possible. The best of 
nursing will be required to prevent bed sores and other complica- 
tions. 

If the patient improves and the more serious symptoms of 
shock abate, there is still danger of fatal result from inflammation 
and disorganization of the brain. If this danger be passed suc- 
cessfully, there may still remain more or less paralysis, inability 
to speak, and other mental impairment. Time will frequently re- 
lieve these conditions, and general tonic medication with electric- 
ity may be of great service. Cerebral hemorrhage, if not fatal at 
the first attack, is likely to recur and ultimately to carry off the 
patient. 



48 



CHAPTER V. 
DISEASES OF THE CEREBRUM, OR LARGER BRAIN. 

CEREBRAL PALSIES OF CHILDREN. 

Children are subject to different forms of paralysis of cere- 
bral origin. These palsies consist of hemiplegia (paralysis on one 
side), double hemiplegia (on both sides) or paraplegia (both 
lower limbs), with spasmodic symptoms, and some wasting of the 
muscles and contractions, to which is often added mental impair- 
ment, and speech defect, or mutism. These palsies may be a re- 
sult of defects of fetal development, of excessive pressure upon the 
brain during the birth process, or of hemorrhage, embolism or 
thrombosis, or sudden cellular disintegration, and other degenera- 
tions not well understood, to which children are especially sub- 
ject during the first three or four years of life. Hemiplegia usu- 
ally occurs before the third year has passed, if at all, and the mental 
powers may or may not be impaired. In cases resulting from con- 
genital causes (accidents at birth), there is frequently marked 
mental defect, and the face is often expressionless. 

The outcome of these cases will depend largely upon the 
amount of damage done the brain. This damage may be so great 
that the mental powers will never develop and the limbs will be 
useless, or it may be so slight that the mind will not be injured, 
nor the use of the palsied limb be entirely lost, although it will 
be smaller and weaker than its fellow. 

But little can be done directly in the way of treatment. Time 
and good general health will lead to much improvement in some 
cases, and the deformities can sometimes be lessened by surgery, 
but operations on the brain are not warrantable. 

TUMOR OF THE BRAIN. 

The brain is subject to the growth therein of various forms of 
tumor, among which are tubercle, sarcoma (the most common 
form of cancer), glioma (an abnormal nerve growth), gumma (a 
syphilitic growth), parasitic cysts and bony growths; other rare 

754 



DISEASES OF THE NERVOUS SYSTEM. 755 

forms need not be mentioned. Tumors of the brain are very much 
more common in men than in women. A few cases occur before 
the twentieth year, most cases between the twentieth and fortieth, 
and more after forty than before twenty. In children, tubercle 
is the most common, in young adults glioma, and after maturity 
sarcoma and gumma. 

The general symptoms of brain tumor are headache, which 
is one of the most constant, but varies greatly in character and lo- 
cation; vertigo, generally slight and vague; nausea and vomiting, 
which may be slight or so severe as to endanger life; neuritis of 
the optic nerve ; convulsions, general and due to disturbance of the 
cerebrum or cerebellum as a whole, or limited to certain muscles 
because of implication of certain motor tracts, and, finally, men- 
tal disturbances, which may be slight or severe and tending to 
drowsiness and coma. There are also likely to be variations in 
the pulse, respiration and pupils ; later, derangement of many func- 
tions, and, at last, paralysis of the bladder and bowel, bed sores, 
etc. 

The tendency of brain tumor is to a fatal issue, but in some 
cases, especially of a syphilitic character, great improvement and 
arrest of progress may follow proper treatment. In some selected 
cases brain tumors have been successfully removed by surgery 
and the patient cured, perhaps the highest triumph of the neurolo- 
gist and the surgeon. 

HYDROCEPHALUS; DROPSY OF THE BRAIN; WATER ON THE BRAIN. 

The surface of the brain and spinal cord, and the natural in- 
terior foldings of the brain constituting the ventricles, are bathed 
and lubricated by a serous liquid called the cerebro-spinal fluid. 
It sometimes happens that because of some disease of the brain or 
its membranes, or some imperfection in development, that this 
fluid is secreted in excess and causes pressure, both upon the brain 
and against the skull. This excess of water in the brain is called 
hydrocephalus. It may be congenital and cause such intra-uterine 
enlargement of the head as to impede, or even prevent, birth ; or 
not apparent at birth, it may develop soon after, or within the 
first few years of childhood. Cases developing in childhood usu- 
ally depend upon meningitis of some kind. Occasionally it de- 
velops later, even in adults. Dean Swift died at seventy-eight, of 
hydrocephalus of three years' duration, dependent, doubtless, 
upon obstruction in the venous circulation. 



756 DISEASES OF THE NERVOUS SYSTEM. 

The most notable symptom of this disease is an unnatural 
distention of the skull, which has a peculiar shape, being rounded 
in front, bulging above the eyes and rather overhanging them. 
The eyes themselves are pushed forward in their sockets and di- 
rected downward. Sometimes the distention of the skull is so 
great that the bones are separated and the "soft" spots," which in 
the healthy child become closed by bone, always remain open 
and, in fact, grow larger. There is generally a good deal of men- 
tal defect, frequently paralysis of one or more limbs, convulsions 
and contractions. The vision may be impaired because of pres- 
sure upon and disease of the optic nerve. Frequently the child 
shows mental irritation, resembling a mild meningitis, such as 
restlessness, sharp cries, disturbed sleep, etc. 

The amount of fluid is usually one or two pints, although 
from six to eight pints, and even more, have been reported. In 
congenital cases the fluid is in the ventricles (cavities) of the 
brain, and the brain substance is thinned and pressed against the 
skull. , 

Hydrocephalus is almost always a fatal disease, although 
those affected with it occasionally live to twenty or thirty years; 
the head sometimes becoming so large and heavy that the patient 
cannot support it in the erect position, but has to continually lie 
in bed, or have the head upheld by artificial support. In a few in- 
stances the disease has been arrested and the patient has lived 
many years with good mental powers, but this is very unusual. 
In congenital cases medicinal treatment is almost never of any 
benefit. In cases occurring as sequels of meningitis medical treat- 
ment may be beneficial. Surgical procedure, by drawing off the 
fluid by compressure of the head, has been tried, but without any 
encouraging success. 

DISEASES OF THE CEREBRO-SPINAL SYSTEM AND 
ITS MEMBRANES. 

CEREBRO AND SPINAL MENINGITIS. 

The membranes inclosing the brain and cord are called 
meninges, and are subject to inflammation — meningitis — which is 
divided into different forms, according to the location or nature 
of the disease, being called tubercular when caused by tubercular 
deposits; suppurative when accompanied by formation of pus; 



DISEASES OF THE NERVOUS SYSTEM. 757 

cerebrospinal when the membranes of both brain and spine are 
affected. Other terms with special technical meanings need not 
be mentioned. 

SUPPURATIVE MENINGITIS. 

Suppurative meningitis is caused by extension of inflamma- 
tion from ear disease, or nasal disease, by purulent pleurisy, and 
infection from other diseases, as well as from injury, exposure to 
cold, and from sunstroke. The very close connection of the ear 
with the brain, the intercommunication between them by veins, 
arteries and connective tissue, and the nearness of the brain to 
the mastoid cells which so often become involved in suppuration 
of the ear, render very liable the extension of the suppurative proc- 
ess to the brain. Indeed, ear disease is the most frequent of all 
the causes of suppurative meningitis. In a similar way disease 
may be communicated from the nasal passages. It may also fol- 
low suppurative pleurisy, and many other suppurative diseases, 
by the passage of infection through the blood vessels. Injury 
to the head, even though not apparently serious, may also cause 
this affection. Exposure to cold or heat, especially direct ex- 
posure of the unprotected head to a very hot sun, are occasional 
causes. 

In meningitis from disease of the ear or nose, the base and 
sides of the brain are most affected, but in infectious cases 
and those from sunstroke the top is more implicated. The post- 
mortem appearance of the brain is, in lighter cases, that of conges- 
tion dotted with pus, but in severe cases the whole surface may be 
bathed in pus. 

Suppurative meningitis may occur at any age, and fatal cases, 
from extension of chronic ear trouble, or from acute involvement 
of the mastoid cells, are not uncommon. Senator Conkling of 
New York died from extension to the brain of ear disease caused, 
or at least made active, by exposure in a very severe snowstorm. 

Symptoms. — The general symptoms are headache, delirium, 
fever, coma, muscular twitchings, convulsions, paralysis. These 
symptoms also attend other forms of brain disease, and the history 
of injury or of previous disease, and the condition of other organs, 
must be carefully examined, especially the ear, nostrils, heart and 
lungs. It will not always be possible for the physician to make a 
satisfactory diagnosis at first. This disease is of a very serious 
nature, although patients sometimes recover. 



758 DISEASES OF THE NERVOUS SYSTEM. 

Treatment. — The treatment will depend largely upon the 
cause. If there is disease of the ear, giving rise to an accumula- 
tion of pus, it should be liberated by an operation. Disease of the 
nasal bones should be removed, if possible. Suitable remedies to 
check inflammation, and antiseptic treatment, together with the 
best care and nursing, are also required. 

CEREBRO-SPINAL MENINGITIS. 

Cerebro-spinal meningitis, first recognized as a distinct dis- 
ease in Europe in 1805, has been known as "spotted fever," "sink- 
ing typhus," epidemic meningitis and many other names, but 
since its pathology has become well settled, it is known all over 
the world by the scientific name given at the beginning of this 
paragraph. Its first recognized appearance in America was at 
Medfield, Mass., in 1806, when it was known as "sinking typhus." 
It was epidemic within the bounds of New England for about ten 
years. In 1822 it occurred in Middletown, Connecticut; in 
1828 in Trumbull County, Ohio; in 1842 in Kentucky, Ten- 
nessee and Alabama, and then became more widely scat- 
tered. In 1864 it appeared in Carbondale, Pennsylvania, and 
caused the deaths of four hundred children in a population of 
six thousand. Various other epidemics, too numerous to men- 
tion, have since occurred, both in Europe and this country, in 
fact, in nearly every civilized land, and it now seems to have be- 
come naturalized in the cities of the United States, and occasion- 
ally appears in the country. 

Cerebro-spinal meningitis is what is termed a constitutional 
malady, that is, a disease which permeates the whole system, and 
the meningitis is simply one of its local manifestations — the most 
striking and important one. The specific poison to which it is 
due has not been discovered, but the weight of opinion is that it 
is caused by a micro-organism. As its name implies, the special 
manifestation from which the most serious symptoms arise is an 
inflammation of the coverings (meninges) of the brain and ad- 
jacent spinal cord. This inflammation varies very greatly in ex- 
tent, and in the stage to which it may attain. It may extend over 
most of the cerebral surfaces, or may be confined to small areas. 
In very acute, quickly fatal cases, the disease of the membranes 
may not have passed beyond the stage of hyperemia (the unnat- 
ural fullness and redness immediately preceding inflammation), 



DISEASES OF THE NERVOUS SYSTEM. 759 

because the vital powers are so overcome by the constitutional 
disease as to produce death, before the inflammatory process has 
had time to go on to other stages. It is generally found, how- 
ever, that the inflammation has fully begun and free exudation, 
either serous, fibrinous or purulent, is found in and beneath the 
pia mater (membrane investing the brain), together with inflam- 
mation of the brain substance itself. 

A study of the location of cases occurring in cities indicates 
that unhygienic conditions favor the development and spread of 
this disease, yet it sometimes attacks those who live with the very 
best city surroundings or in healthful country places. Nearly 
three-fourths of the cases occur in children under ten years of 
age. As a rule the onset is sudden, generally with headache, 
vomiting and a chill or convulsions, followed by fever; drowsiness 
occurs in slight cases, delirium and coma in severe ones. In some 
epidemics there is a mottled appearance of the skin, or a rash, or 
numerous minute extravasations of blood — phenomena which 
have given the malady one of its names, "spotted fever." As the 
disease goes on, the eyes are likely to be drawn and the pupils act 
irregularly. The headache becomes very severe and the head 
is drawn back, or the whole body is curved backward by the con- 
traction of the posterior muscles so only the back of the head 
and the heels touch the bed. Sometimes there is muscular paraly- 
sis, more or less marked, and other symptoms pointing to the in- 
volvement of various nerves. 

In very violent cases death may ensue within twenty-four 
hours ; others last one or two weeks, and sometimes three or four 
weeks. When recovery occurs it generally comes within four 
weeks. About one-half the cases are fatal, and in many which 
survive irreparable damage has been done the nervous system, 
which is more likely to cause paralysis than mental impairment. 

Treatment. — The treatment is beset with difficulties. In very 
severe cases death comes before there is time for palliative treat- 
ment. In those of less violence there should be, first, the best 
of nursing. No one should be allowed to see the patient but the 
physician and nurse. In no other disease is quiet more important. 
Great harm may be done by the officious meddling, so common 
when kindly disposed neighbors run in to help. Even apparently 
uncomfortable positions and lack of cleanliness would better be 
permitted rather than disturb the patient. The strictly medical 



760 DISEASES OF THE NERVOUS SYSTEM. 

treatment will depend a good deal upon existing conditions. In 
general, cold to the head with warmth to the extremities is in- 
dicated. Among drugs, those which contract the arterioles and 
lessen the circulation in the brain, those which tend to lessen ex- 
udation and later stimulate its absorption, and those which tend 
to keep up the functions of respiration and circulation, together 
with such as have a soothing, quieting and hypnotic effect, are 
of great value when intelligently used. Of course, so serious a 
disease demands the best efforts of the most skillful physician. 

The most careful attention should be given to the diet, 
which should be light and easily digested. If convalescence be 
established, remedies to promote absorption and to stimulate di- 
gestion and nutrition should be employed, as usual. 

TUBERCULAR MENINGITIS. 

That the general reader may gain a clear understanding of 
tubercular meningitis, brief attention must be given to what tuber- 
culosis really is. 

Tuberculosis is an infectious disease, caused by the tubercle 
bacillus, and characterized by the production of tissue and inflam- 
matory products, which appear in the form of nodules, and also 
as a more diffused infiltration, and which rapidly undergo a 
cheesy degeneration. The tubercle bacillus is a micro-organism 
which may find its way into the system through the air passages ; 
through the food passages, by contact with abraded surfaces, etc. 
This bacillus is so common and abundant that it no doubt finds 
entrance into every individual. In the strong and vigorous it 
finds no suitable soil and makes no lodgment, but when the sys- 
tem is susceptible, on account of hereditary weakness, debility 
from acute disease, impaired nutrition, exhaustion from any cause, 
etc., the germ gains a hold and the infection is accomplished. The 
bacillus now multiplies in the different tissues, according to cir- 
cumstances, causing the formation of tubercular nodules, inflam- 
mation, destruction of tissues, etc. These nodules vary in size, 
but, scattered through the substance of the part affected, they 
are often about as large as a millet seed, hence are called "miliary ;" 
by a process of aggravation or extension, they may become much 
larger. 

The whole system becomes more or less infected and the 
bacilli are carried to all parts through the blood. In certain cases 



DISEASES OF THE NERVOUS SYSTEM. 761 

they lodge in the pia mater (the delicate membrane covering the 
brain) and miliary tubercles develop therein, setting up a form of 
inflammation called tubercular meningitis, which, as will be un- 
derstood in the light of the foregoing statements, is not an inde- 
pendent affection, but one of the most important phases of a most 
formidable malady — acute miliary tuberculosis. 

In attacking so vital an organ as the brain and causing serious 
symptoms and fatal issue with great rapidity, the local disease so 
far outweighs the immediate danger from the general infection as 
to warrant a special name and special attention. 

Tubercular meningitis is, therefore, an acute inflammation 
of the pia mater of the brain caused by a deposit of miliary tuber- 
cular granules, and characterized by an effusion of pus and lymph. 
There are two forms of this disease : (i) The primary, in which at- 
tention is first called to the tubercular infection by the develop- 
ment of the meningitis, and (2) the secondary, in which the in- 
volvement of the brain is subsequent to well marked tuberculosis 
of other organs and near the close of the illness. It is only the 
primary form which will be considered here. 

Tubercular meningitis, primary, is a disease of childhood, 
generally occurring between the ages of two and ten, and is one 
of the most important and most fatal organic diseases of the 
cerebro-spinal system. The symptoms which precede its full de- 
velopment are usually vague. There is a tendency to emaciation 
and paleness ; the child becomes peevish and listless, and loses 
its interest in its usual pleasures. It is likely to sleep poorly and 
to complain of local headache. Digestion is impaired, with occa- 
sional regurgitant vomiting. The eyes become impatient of light, 
there is a little fever and the pulse becomes irregular. After a 
week, or several weeks, symptoms become more marked. Res- 
piration becomes irregular, the eyes half close and move slowly 
from side to side, and one or both pupils dilate. As the disease 
progresses there are more decided evidences of the damage done 
the brain, such as twitching of the muscles of the face, turning 
in of the eyes, convulsions and paralysis of the face and extremi- 
ties. The fever increases, the head is drawn back, the pulse grows 
more frequent and full, the respiration is disturbed and death 
closes 'the scene in from three or four days to four weeks. The 
base of the brain is most usually affected, especially the region 
where the olfactory, optic and third nerves are situated, and this 



762 , DISEASES OF THE NERVOUS SYSTEM. 

accounts for some of the earlier symptoms involving the eye — 
the later symptoms arise from pressure and disorganization of the 
brain. In examinations after death, the delicate, transparent, 
glistening pia mater is found to be thickened, opaque, studded 
with tubercles, which look like little grains of rice, and bathed 
in an exudation of serum, lymph or pus. The brain substance 
shows marked changes under the microscope. 

In many cases it is not difficult for the physician to determine 
when a child has tubercular meningitis; in other cases it may be 
very difficult. But very few cases of this disease recover. Indeed, 
many of the best practitioners, especially skilled in this class of 
diseases, declare they have never seen recovery. But the bare 
possibility of recovery, as well as the comfort of the patient and 
satisfaction of friends, unite to induce the most careful and intel- 
ligent treatment and nursing. Absolute rest, guarding against 
any disturbance which may in any way affect the sensations, the 
ministrations of a competent, careful nurse, who has a good deal 
of tact, a darkened room, medicines and food to be given with the 
utmost regularity, are of great importance. The physician will 
prescribe such medicines as the symptoms indicate. 

LEAD POISONING. 

Certain peculiar nerve and brain lesions are caused by poison- 
ing by lead, which may find its way into the system by the mouth, 
skin and lungs. 

There are many occupations which cause exposure to the 
poisonous action of lead, such as working in lead factories, paint- 
ing, plumbing, typesetting, etc. There are also occasional sources 
of lead poisoning, as the use of water conveyed in lead pipe, the 
glaze of earthenware vessels and fruits preserved in cans, the tin 
of which is adulterated with lead, When slowly taken into the 
body it is stored up in muscles, kidneys, brain and bones. 

Symptoms. — The general symptoms of lead poisoning are the 
so-called lead cachexia (due to impairment of the blood and weak- 
ness of the muscles), the lead line on the gums (an irregular blu- 
ish-black line at the junction of the teeth and gums), colic, pains, 
paralysis, cerebral complications and other nervous phenomena. 

Lead colic is a very obstinate, painful colic, dependent upon 
the action of the lead upon the intestinal nerves, attended by 
vomiting and obstinate constipation, and pains which are variable 



DISEASES OF THE NERVOUS SYSTEM. 763 

and appear to be in the muscles near the joints. But the 
symptoms of lead poisoning to which special attention will be 
given are the muscular paralysis and cerebral complications. The 
typical paralysis from lead poisoning is popularly known as 
"wrist drop." When the wrist drop is complete the patient's 
hands, when extended palms downward, drop at the wrist and 
cannot be held straight out. This is because of paralysis of the 
extensor muscles, as they are called, of the wrist, that move the 
hand in the direction of its back. Sometimes the muscles of the 
arm and shoulder are affected, also those extending the foot, 
causing "'ankle drop." The affected muscles become atrophied — 
sometimes with cramps and tremor. There is also likely to be 
some impairment of sensation. In severe cases the brain is at- 
tacked and there may be convulsions, delirium, coma, loss of 
sensation, and of motion of part of the body, chronic mental dis- 
turbance simulating melancholia or general paralysis ; and some- 
times an active inflammation of the brain, called lead encephalitis 
(lead inflammation), which may be followed by coma and is likely 
to prove fatal. 

The method by which lead poisoning causes the paralysis 
mentioned is by setting up a neuritis and thus cutting off the 
muscles from the nervous stimulation necessary to muscular ac- 
tion. The muscles atrophy from disuse. Similar processes in the 
brain produce the general cerebral symptoms mentioned. The 
physician, ordinarily, has little or no difficulty in recognizing lead 
poisoning, although similar manifestations may follow poisoning 
by other metals, as arsenic and silver. A positive diagnosis can 
sometimes be made in doubtful cases by a careful chemical ex- 
amination of the urine, from which lead can be recovered. 

Cases of ordinary simple lead poisoning, that is, of neuritis 
caused by lead, are almost always curable by removing the lead 
from the system, building up the general health, and stimulating 
the impaired muscles and nerves by galvanism. The drugs more 
especially useful are iodide of potassium to increase the excretion 
of lead by the kidneys, sulphate of magnesia to counteract and 
carry it off by the bowels, and iron, quinine, good food, etc., to 
build up the system. Severe pain in the attacks of colic must be 
relieved by anodynes, such as opium, hyoscyamus, etc. When 
the system has been thoroughly saturated by lead, so long con- 
tinued as to produce the severe cerebral symptoms, the outlook is 
less favorable. 



CHAPTER VI. 

THE NEUROSES. 

There are certain diseases which appear to have their seat in 
the nervous system, which are indicated by disordered sensation, 
volition or mental manifestation, without any evident lesion in 
the nervous structure and without any material agency acting to 
produce them — in other words, they are functional disorders which 
are called neuroses. 

It is true that with the great advances in our knowledge of 
pathology the lesions causing some classes of these diseases have 
been determined, and it is likely that more may be known of the 
subtle elements of causation, in the future, but it still seems best, 
especially in a popular work, to follow the old way and group these 
diseases under the old name. 

EPILEPSY. 
(Fits.) 

The term epilepsy is derived from a Greek word, which 
means "to seize upon," and is applied to this disease because of 
the convulsions which seize upon the victim. There are several 
forms of epilepsy, the most common of which is called grand mal, 
a term transferred from the French and meaning great sickness, 
or major epilepsy. 

In a typical attack of epilepsy there is a sudden loss of con- 
sciousness, a sudden sharp outcry (this symptom is sometimes 
missing), a fall, convulsion, blueness of the face, partial regain- 
ing of consciousness and then deep sleep for an hour or more. 
In falling the patient is likely to injure himself. In the convulsive 
stage the tongue is frequently bitter, and with return of respira- 
tion (which was arrested in the first part of the convulsion) the 
retained saliva is whipped into a foam, causing "frothing at the 
mouth." There are almost numberless variations from this type, 
the most frequent of which consists of brief loss of consciousness 
without falling and with little or no convulsive movement. This 
form is known as petite mal, the little sickness, or minor epilepsy. 

764 



DISEASES OF THE NERVOUS SYSTEM. 765 

The epileptic seizures may come on without any warning, or 
they may be preceded by peculiar sensations in different parts of 
the body. Each case is a law unto itself in relation to this pre- 
liminary warning, called aura, meaning a sensation as of a gentle 
air current, commencing in a foot, hand, pit of the stomach or 
other part, and seeming to move toward the brain. 

Although epilepsy is classed among the neuroses — functional 
nervous diseases — modern research has shown many cases to be 
due to demonstrable disease. Probably in every case there is 
some modifying, morbid condition of the nervous system, al- 
though not recognizable bv anv means vet devised. 

Practically, therefore, epilepsy is divided into two great 
classes ; the one where it is a symptom of some recognizable or- 
ganic disease, the other where no disease can be recognized, called 
respectively symptomatic epilepsy and idiopathic epilepsy. 

Symptomatic epilepsy may be caused by tumors of the brain 
and cord, by meningitis of any kind, by cerebral palsies and many 
other forms of brain disease. It may also be due to traumatic 
causes (injuries), especially such as produce depression of the skull 
and irritation of the brain from sharp pieces of displaced bone. A 
case of long continued epilepsy under my care in which no cause 
could be discovered during life was after death found to be caused 
by the formation of a bony growth in the membranes of the brain, 
not connected with the skull, and which irritated the brain by its 
pressure and sharp points. 

In many cases epilepsy is brought about, originally at least, 
by irritation at some peripheral point, and is a reflex phenomenon. 
As an illustration, which will show this mode of causation and ex- 
plain the use of "reflex," the case of convulsions from teething 
may be cited. A child inherits a susceptible, unstable nervous or- 
ganization ; teething comes, perhaps in hot weather, when the child 
has become unusually susceptible from heat, sleeplessness, etc. ; in 
the tooth-cutting process the gums become swollen and tender, the 
nerve filaments are involved and in turn the brain becomes irri- 
tated and discharges nervous shocks along the motor lines, caus- 
ing convulsions. Such convulsions are called reflex. Continued 
irritation from the same or other sources may produce successive 
convulsions until at length the habit is set up, the nervous force 
continues to be discharged in shocks along the same lines, now 
the lines of least resistance, and full-fledged epilepsy is estab- 
lished. 



766 . DISEASES OF THE NERVOUS SYSTEM. 

The causes of idiopathic epilepsy are not well understood; 
even careful investigation after death fails to find pathological 
causes for the disease. Epileptic seizures in many cases occur 
with something akin to periodicity. Nocturnal epilepsy, as its 
name implies, occurs only at night and may long be unsuspected 
by the patient or his friends. The seizures are likely to cluster 
around the menstrual period, or to be grouped at irregular inter- 
vals. Even when they occur daily there will be times of increas- 
ing and diminishing numbers. The frequency of attacks when 
on-coming or when fully established is very variable. The first 
seizures may be years apart, growing nearer together with a 
geometrical ratio, as time goes on. When fully established there 
may be many attacks daily or only occasional seizures. In 
chronic cases the seizures may become very frequent, a great many 
in a day. Sometimes the patient goes into a state of continued 
convulsion, which may last for days, called status epilepticus, 
which is generally fatal. 

Treatment. — The treatment of epilepsy will depend largely 
upon the peculiarities of the case and the cause. In cases arising 
from determinable brain lesion, tumor, abscess, injury, etc., within 
the scope of modern brain surgery, operation should be had ; but 
it is plainly useless to attempt surgery in cases caused by con- 
genital defect. If there be reflex irritation from the teeth, stom- 
ach, genital organs, etc., the cause of irritation should be removed, 
if possible, by medicines or surgery; but removal of the cause is 
not sufficient, for whenever epilepsy is once set up it has a tend- 
ency to become permanent. 

There are various remedies which often have a favorable ef- 
fect upon epilepsy in a way not well understood. The most valu- 
able of these are the bromides of potassium, sodium, ammonium, 
etc. To produce beneficial results the bromides must be given in 
doses sufficient to show constitutional effect, and for a long time. 
Such long-continued use of these remedies is apt to depress the 
general health. Hence, it is important to combine the different 
salts, and to use with them other remedies to counteract their ef- 
fect. Occasionally there is found a case in which the bromides 
are harmful, and they cannot be continued. Sometimes the long- 
continued use of bromides causes disagreeable eruptions, especially 
on the face. Judicious use of correctives will do much to prevent 
this complication. Many other drugs prove serviceable at times. 



DISEASES OF THE NERVOUS SYSTEM. 767 

Indeed, improvement for a time is frequently seen to follow the 
use of any new medicine, or even a change of residence. The ad- 
vertising quack who gets his wares before the notice of epileptics 
reaps a golden harvest. Far better to depend upon the family 
physician, who can see the case frequently and watch it carefully, 
and whose treatment will be scientific and trustworthy. 

Strict attention should be paid to diet. Chronic epileptics are 
prone to be hearty eaters, which tendency is harmful. The food 
should be mild, unstimulating and limited to the requirements of 
the system. In those cases which experience a distinct aura, or 
warning of the approach of a fit, the inhalation of nitrite of amyl 
will prevent the seizure. From a mistaken sympathy, parents are 
inclined to neglect proper control of an epileptic child, to pet it too 
much and allow it to dominate the family until it develops into a 
wayward, cruel, family and neighborhood terror. No harshness 
should be shown these unfortunates, but gentle, continuous, tact- 
ful, moral control is very necessary, to the end that the higher 
moral sentiments be cherished and developed. Too often epilepsy 
develops in families affected with insanity, intemperance and the 
nervous and other constitutional disorders which render the pa- 
rents undesirable care-takers for the defective child. The tendency 
to transmit epilepsy is so great that no epileptic ought to marry. 

The cure of epilepsy is a very uncertain problem. Certain 
surgical and reflex cases promptly treated are cured ; other cases 
may be much benefited and the seizures greatly mitigated, both in 
frequency and severity ; still other cases cannot be materially bene- 
fited. Minor epilepsy is very rarely helped by treatment. The 
general effect of epilepsy is to produce mental deterioration, but 
there are exceptions to this rule, and some notable persons who 
have won distinction have been subject all their lives to occasional 
epileptic seizures. Epileptic insanity and the peculiar automatic 
mental condition due to epilepsy will be considered with the in- 
sanities. 

CHOREA. 

(St. Anthony's Dance. St. Vitus' Dance.) 

Chorea is a functional nervous disease characterized by invol- 
untary muscular twitchings, jerky movements or wavy undula- 
tions. These phenomena may be confined to one side, but sooner 
or later involve all the muscles. 

They may be slight in character, so as to require careful and 



768 DISEASES OF THE NERVOUS SYSTEM. 

patient examination to discover them, or so violent as to throw 
the patient out of bed, unless secured or guarded. The first at- 
tack usually occurs in childhood, and more frequently in girls than 
m boys. Chorea may prove curable in the first two or three 
months, but in most cases some odd-styled movements remain 
through life as a legacy from the disease in childhood. Not a few 
cases take on a rapid development, and may sooner or later prove 
fatal from exhaustion. Indeed, certain types of this disease are 
speedily fatal. 

Chorea attacks children of active and energetic bodies and 
minds; dullards are not subject to it. The choreic child is using 
its energy too fast, exhausting itself. The first indication for 
treatment, therefore, is to lessen this overexpenditure of energy; 
and the second, to strengthen the system by good food, iron, 
arsenic, cod-liver oil and electricity. The little patient should be 
put to bed for one, two or three weeks in a sunny, well ventilated 
room, well warmed if it be cold weather. As the child improves 
it may be permitted to be up and dressed an hour in the after- 
noon, increasing the time according to circumstances, but it 
should get up late, retire early and not be allowed to fatigue itself 
for one, two or three months. While all the remedies mentioned 
are important, the combination of iron and the arsenical prepara- 
tions have the most specific effect upon this disease. It is im- 
portant that during this period of enforced idleness the patient 
should have sunshine and fresh air and sufficient diversion to pre- 
vent mental discomfort. After recovery he should be carefully 
watched for indications of return, and put under treatment again 
if any symptoms be manifested. Acute cases with rapid pulse 
and quickened respiration are very serious and usually fatal. 
Chronic chorea is very intractable and renders the victim help- 
less and pitiable, and ultimately leads to fatal exhaustion. 

HYSTERIA. 

Hysteria, included among the functional nervous diseases, is 
a disorder with the most remarkably varied manifestations, which 
depend upon a peculiar increased reflex excitability of the cerebro- 
spinal i nervous system, with decrease of the natural controlling 
will power. It is very commonly supposed that the symptoms of 
this disorder are an alternation of laughing and crying, with a 
choking sensation, as if something were coming up in the throat ; 



DISEASES OF THE NERVOUS SYSTEM. 769 

but only in a very small proportion of cases are these symptoms 
manifested. Among the causes of hysteria heredity is very fre- 
quent. This does not mean that the disease in parent and child 
is always the same ; but that in the parent there existed some 
neurotic or psychic disease. Indeed, hysteria, epilepsy, insanity, 
intemperance and other similar manifestations run through gen- 
eration after generation in varied succession. 

Various diseases, injuries, unrestrained emotion, mental and 
physical strain, etc., are likely to cause hysteria, both in those 
who are predisposed and those who are not. Imitation and men- 
tal contagion account for hysterical epidemics sometimes seen in 
schools for girls, or in neighborhoods. It is much more frequent 
in women than in men. 

The general symptoms may be divided into mental, sensory, 
motor, visceral and convulsive. The mental manifestations may 
vary from apparently simple caprice or lack of self-control to 
the severity of epilepsy, the stupor of coma or the excitement 
of the most violent acute mania. In the hysterical subject the 
emotions are not under natural control or check, there is lack of 
self-restraint, the appreciation of the fitness of things is deranged, 
and the judgment is impaired. Hence slight and ordinarily insuf- 
ficient influences cause the hysterical individual to laugh or cry, 
to be pleased or angry, elated or depressed, charmed or fright- 
ened. Everything runs to excess. 

The sensory symptoms are equally changeable, infinite in 
character and variety, and referable to both sensory and motor 
nerves and all parts of the body. There may be unnaturally acute 
sensation so that the slightest nerve irritation produces profound 
disturbance, or sensibility may be so in abeyance that the thrust- 
ing of needles through the rlesh is not noticed. 

The visceral symptoms are varied and may simulate almost 
any form of abdominal disease. The convulsions of hysteria dif- 
fer from those of epilepsy; the loss of consciousness is not com- 
plete, the patients do not fall in such a way as to injure them- 
selves, the convulsive movements are of a different character and 
the circulation and respiration are less affected. 

Hereditary forms of hysteria are very rarely cured, although 
great improvement may be brought about by removing the excit- 
ing cause and building up the general health. What may be called 
accidental cases in those not predisposed are curable. 

49 



770 DISEASES OF THE NERVOUS SYSTEM. 

To successfully treat hysteria the physician must be a broad- 
gauged, many-sided man. No disease calls for more intelligence* 
knowledge of human nature, tact and skill in medicine. Both the 
individual and the surroundings must be most thoroughly studied, 
the confidence of the patient gained and the will roused to energy 
by skillful suggestion, emphatic command or some other method. 
Hysteria is a most deceptive disease to one who has it. Every 
little actual ailment, and even imaginary ones, are magnified 
and dwelt upon till the mind is wrought into the same condition 
as if weighed down by actual organic disease. Well meaning 
but misguided relatives and friends, who do not understand the 
true state of affairs, by dwelling upon the case and showing their 
anxiety, add fuel to the flame, and the mental incubus growing 
by what it feeds upon obtains complete control, the patient re- 
signs herself to an imaginary fate, or turns to suicide. Many a 
young person brought face to face with some civil or personal 
responsibility and harassed by hysterical fears of incapacity, no- 
tions of unfitness or apprehensions of results, seeks "surcease 
of sorrow" by a wild fling into the unknown beyond. While 
writing this article, I see in the daily paper an account of a young 
girl who, expecting to graduate from the high school she has 
been attending, is informed by the principal that she has failed 
to pass in one of her studies, and in a state of hysterical depression 
commits suicide with rat poison. 

The hysterical field yields a rich harvest to the quack, whose 
sometimes genuine cures do not prove that there is no such thing 
as disease, or material body, and that everything is spiritual ; but 
it does show that mental energy aroused through confidence may 
abate the morbid belief and allow the ordinary functions and power 
to resume their normal sway. 

In former times, when hysteria was not recognized as a dis- 
ease, but was looked upon as a misdemeanor (to use a very mild 
term), the attempt was often made to eradicate the evil by harsh 
means, even severe punishment, but such a course is altogether 
indefensible. Sagacious ways of impressing the patient, tactful 
turning of the mind into normal channels, or even a harmless shock 
to arouse self-control, are admissible and often very beneficial. 
Such aid judiciously selected and timed not infrequently proves 
to be the moral stimulus which enables the patient to regain men- 
tal balance and thus promotes a cure. 



DISEASES OF THE NERVOUS SYSTEM. 771 

A sagacious and experienced medical friend was once called 
to one of this class of patients, who was thought by her family 
to be very ill and who apparently had been unable to speak for 
several weeks. The girl was found lying in bed with a wealth 
of beautiful hair sweeping the floor, seemingly unconscious of 
her surroundings and unable to speak. Taking in the real situa- 
tion, with that acumen for which the physician was noted, he gath- 
ered the hair in his hand and said slowly: "What a burden this 
heavy hair must be in this hot weather; nurse bring me the shears." 
The patient instantly roused up and exclaimed : "You are not 
going to cut off my hair, are you?" These were the first words 
she had spoken for weeks ; but she had found her tongue and 
quickly regained her normal self-control. 

A very intelligent practitioner in a neighboring county, while 
making a professional visit, was incidentally asked by a lady who 
had been unable to walk for a year how best to bandage her 
offending foot. Upon examination the doctor became satisfied 
that no real disease was there and that her inability to use it was 
hysterical. He fixed the patient's attention and impressively told 
her that he would cure her disabled foot then and there. With a 
few brief authoritative commands, in a few minutes he had her 
put her foot to the floor, bear her weight, take a step, walk across 
the floor, out into the yard and back ; and the cure was complete. 

A young woman of exceptionally fine physique, but who had 
inherited an unstable, neurotic temperament, was brought to my 
care by her physician, who with the help of a companion carried 
her in and laid her upon a bed, because of her supposed inability 
to walk. The doctor had told me in her hearing that she was 
continually having convulsions and that it required one or two 
persons to keep her from falling off the bed. After she was 
placed upon the bed I directed all to withdraw to the adjoining 
connecting room. The physician exclaimed, "It will not do to 
leave her alone; she will throw herself off." "We will leave her," 
I replied. Then turning to the nurse in charge I said in a dis- 
tinct voice: "If she throws herself off the bed, put the mattress 
on the floor and let her lie there." After we had gone she threw 
herself off the bed and was put upon the mattress on the floor, 
but she never repeated the performance. The next day she had 
full control of all her limbs, and never again fell off the bed or 
had any difficulty in walking. 



772 . DISEASES OF THE NERVOUS SYSTEM. 

It sometimes happens that a patient becomes fixed in some 
erroneous belief because of a mistaken diagnosis by the physi- 
cian. A case of this kind is reported by a well-known physician 
of New York. A bedridden young lady, daughter of an eminent 
clergyman, was declared by a surgeon to be suffering from a 
disease of the breastbone and ribs that would require a difficult 
operation. Finally another physician was called who after a 
critical examination exclaimed: "Get out of bed, put on your 
clothes, go down stairs and meet your mother in the parlor." 
She mechanically obeyed him, was soon entirely well and no re- 
lapse followed. The doctor had recognized in her an obstinate 
case of hysteria, which needed the stimulus of a sudden com- 
mand from a will stronger than her own. These are examples 
of the class of cases which are cured by the faith healer, and the 
cures claimed to be scarcely short of the miraculous. 

SOMNAMBULISM. 

There are several abnormal mental conditions of unconscious 
or sub-conscious cerebration, as somnambulism, trance, catalepsy, 
night terrors, hypnotism, etc., which may properly receive brief 
mention. Somnambulism, or sleep walking, is a curious phase 
of unconscious, nocturnal cerebration somewhat analogous to 
hypnotism and to the double consciousness which is sometimes 
seen in epilepsy. The somnambulist carries on mental processes 
and performs physical acts unconsciously, while in a sleeping state. 
These operations are generally a continuation or completion of 
some study, work or undertaking in which the subject has been 
actively engaged and deeply interested ; but sometimes the pro- 
cesses and acts are without precedent and entirely foreign to the 
patient's usual habits of thinking and acting. 

Students have arisen in the night and completed essays or 
solved difficult problems in mathematics ; a boy while asleep has 
made an accustomed trip to a neighbor's for milk ; a farmer has 
gone to his barn and worked for several hours at his old-fashioned 
threshing, all unconscious of what they were doing. In other 
instances the somnambulist has attempted to put out an imag- 
inary fire, to save his wife and child from a supposed wild beast, 
or plunged into a pond to rescue a fictitious sister from drown- 
ing. Criminal acts have also been attempted or accomplished in 
this state. A pupil, while somnambulistic, attempting to stab his 



DISEASES OE THE NERVOUS SYSTEM. 773 

teacher, was disarmed and taken to another room, where he slept 
until morning, when he had no recollection of what had taken 
place. A man in this condition imagined that he saw, a wild 
beast attack his child who was in bed, and that he seized the 
beast and dashed it to the floor, only to find, when awakened, 
that he had killed his child. A most worthy tradesman of good 
habits was once under my care for somnambulistic attacks in which 
he repeatedly attempted to strangle his wife, to whom he was 
devotedly attached. 

In most cases of somnambulism there has been exhaustion 
of the mental or physical strength, or both, the general health 
has run down, there is special mental anxiety, or there has been 
some reflex irritation to which is usually added some immediate 
exciting cause. 

Treatment. — Treatment is usually successful in breaking up 
the habit, but it must be judicious, founded upon a thorough 
understanding of all the elements of the case, and be varied as 
the conditions indicate. Rest or change of occupation to relieve 
physical or mental stress and medicines to lessen nervous irrita- 
bility and to build up the general health, may one or all be re- 
quired. Normal suggestion, peremptory command, or even hyp- 
notic suggestion may serve a useful purpose by mental impres- 
sion. Sometimes a case is very obstinate and measures must be 
taken to prevent injury to the patient or to others. The occa- 
sional slight attacks experienced by a great many once or twice 
in a lifetime are of no consequence, and it is only when the attacks 
are frequent, habitual or dangerous that they require special 
attention. 

TRANCE. 

Trance or lethargy, a rare form of nervous disorder, is a peculiar 
sleep-like state from which the patient cannot be roused, or can be 
only partially roused, and is not due to organic disease of the brain, 
or to any poison, and is not dependent upon any general bodily 
disease. Cases of paroxysmal attacks of real sleep from which 
the patient can be completely aroused ought not to be confounded 
with trance. It is closely allied to catalepsy, somnambulism and 
hysteria, has the same general causes as hysteria, and sometimes 
occurs in connection therewith. A similar condition is some- 
times seen in the insane, especiallv in chronic delusional insanity. 
Trance usually comes on suddenly, or it may follow typhoid 



774 DISEASES OF THE NERVOUS SYSTEM. 

fever, influenza or similar diseases, and may last from a few hours 
to several weeks. During the attack, especially if prolonged, all 
the vital forces are depressed. In some cases the mental func- 
tions seem to be in complete abeyance, in others the patient may 
be aware of what is going on around him but be unable to speak 
or move or manifest any consciousness. Indeed, the special 
senses may be preternaturally acute. Sometimes exclamations 
and movements indicate a mental condition similar to dreaming 
and in some cases actions can be excited by suggestions made to 
the patient. Most cases of trance recover physical and mental 
health; but in cases which follow severe exhausting disease, or 
which accompany insanity, the outcome is less favorable. 

In the treatment of this disorder there are two distinct ends : 
To sustain the bodily powers and to arrest the seizure. For the 
first, advantage should be taken of any semi-conscious periods to 
give food, otherwise recourse must be had to feeding with the 
stomach tube. The most careful attention to the condition of 
the bowels and bladder, to keeping the extremities warm, to pre- 
venting bedsores, etc., must be given. In severe cases nothing 
which can be done will rouse from the lethargy, and the slow 
progress of nature must be awaited ; but in mild cases external 
stimulants may rouse the patient more or less quickly and com- 
pletely and cut short the attack. 

CATALEPSY. 

Catalepsy is more frequent in women than in men, and during 
early adult life than in more mature years. In many respects 
it is akin to hysteria and is brought about by similar causes. 
Nervous exhaustion is the general predisposing factor, and emo- 
tional disturbance, sudden alarm or injury the usual exciting cause. 
It is frequently seen in connection with melancholia. 

Catalepsy is frequently preceded by headache, giddiness, etc., 
but the onset of the special symptoms is usually sudden and 
accompanied by loss of consciousness. The muscular system, in 
whole or in part, becomes rigid; the limbs remain in the position 
in which they were at the onset, as if petrified. After a while 
the rigidity becomes less and the limbs can be moved and placed 
in any desired position which they retain for a time, gradually 
yielding" to gravitation. The countenance is usually expression- 
less and the respiration and circulation are weakened. In pro- 



DISEASES OF THE NERVOUS SYSTEM. 775 

found catalepsy sensibility to touch, pain and electricity is lost ; 
even the eye does not respond when touched. In other cases the 
symptoms are not so marked, partial sensibility remains and con- 
sciousness is not entirely lost. Attacks may last a few minutes 
or may continue for several hours. In cases connected with mel- 
ancholia I have known catalepsy to continue more or less com- 
plete for weeks or months: 

Recovery may be sudden or gradual. Sometimes there is 
a peculiar periodicity in the attacks. Between the attacks various 
nervous conditions may be present, or the patient may appear 
perfectly well. During the acute attack but little can be done 
in the way of treatment except external stimulation, as by ammo- 
nia, dashing cold water into the face, and especially giving a good 
pinch of snuff, with a view to arousing consciousness. Emetics, 
especially such as can be given by subcutaneous injection, will 
break up paroxysmal conditions. In connection with insanity, 
long continued cases require very careful nursing and feeding. 
I have seen these cases recover after long and severe attacks in 
which the patient was wasted almost to a skeleton ; in other cases, 
in spite of the best care and nursing, a fatal result could not be 
avoided. 

NIGHT TERRORS. 

Children are sometimes subject to attacks in which they, 
suddenly start up in sleep with an agonized cry, staring eyes 
and twitching face, and appear to be thoroughly frightened. 
Neither persuasion or soothing have any effect for a considerable 
time. Such attacks, called night terrors, are similar to somnam- 
bulism, but affect children only and do not lead to "sleep walk- 
ing." The causes are much the same as those of somnambulism, 
barring those which are excluded by the tender age of the subject. 
Heredity, bad health, indigestion, constipation and worry pre- 
dispose, and overeating, worms, mental strain, etc., bring on 
the immediate attack. 

The treatment is usually less difficult than that of somnam- 
bulism. Any physical disorder or irritation should be corrected, 
the diet carefully regulated, the evening meal especially should 
be a light one, the mind should be soothed and the nervous sys- 
tem quieted by bromides, belladonna, tepid baths, etc. 



776 DISEASES OF THE NERVOUS SYSTEM. 

HYPNOTISM. 

It is not intended to give an exhaustive account of hyp- 
notism and its allied conditions, but simply to briefly state some 
well recognized and generally admitted facts- regarding these con- 
ditions, from the standpoint of candor, conservatism and honesty. 
And first, it may be said that it is somewhat difficult to select 
facts well recognized and generally admitted, for it is true that 
great diversity of opinion regarding hypnotism and its congeners 
exists among those who claim to practice it and to explain its 
principles. There is a wide distinction between knowing and un- 
derstanding. Furthermore, those who claim to know and to 
understand may be, and often are, mistaken or self-deceived, or 
they may be conscious hypocrites and intentional deceivers. Be- 
sides, many people say they will not believe what they cannot 
understand, thus confusing knowing with understanding. They 
are so accustomed to the ordinary natural phenomena that they 
are led to think them easily understood. They know that seeds 
under favorable conditions will germinate and bring forth their 
kind, but they understand nothing whatever of the vital prin- 
ciple which directs in turn the reproduction of plants and the 
formation of seeds. 

The scientist may go a long series of steps beyond the lay- 
man in his studies of various phenomena; may determine the 
nervous stimulation and method of contraction by which muscles 
perform their work, demonstrate that mental action is carried 
'on by the cortical gray matter of the brain and show that nervous 
impulses are transmitted by the white nerve fibers, but the subtle 
element of vitality which bridges the chasm between the inert- 
ness of lifeless clay and the physical and mental activities of the 
living body remains an unsolvable mystery. If, then, no one 
can thoroughly comprehend normal and usual mental activity, 
how much less can anyone be expected to understand the peculiar, 
changed and uncommon if not unnatural phenomena of hypno- 
tism ; for after eliminating fraud and self-deception, on the part 
of both operator and subject, there no doubt remains sufficient 
evidence to establish the existence of the hypnotic state. 

Hypnotism appears to be allied to somnambulism, trance, -cat- 
alepsy and hysteria. Its phenomena, formerly known as mesmer- 
ism, have been more or less observed, under different names, 
for many centuries. The supposed supernatural manifestations 



DISEASES OF THE NERVOUS SYSTEM. 777 

by the fakirs of India, the magicians of Persia, the oracles of 
Greece, the seers of Rome, the priests and priestesses of Egypt, 
the monastic recluses of the Middle Ages, the ecstatics of the 
seventeenth and early part of the eighteenth century, and many 
other similar phenomena, not classed as supernatural, are readily 
explained by what we know as hypnotism. 

There is a great difference in persons as to susceptibility to 
hypnotic influences ; some yield easily, others cannot be affected. 
There are various ways of hypnotizing which need not be dwelt 
upon here, but in order to succeed the patient must be in a state 
of receptive expectancy. With repetition the hypnotic state is 
more and more easily induced until in some susceptible subjects 
the snapping of the finger, a single word or even a glance will 
cause complete hypnosis. In the full hypnotic state the will 
of the subject appears to be completely under the control of 
the operator and he obeys the most absurd commands and per- 
forms the most ridiculous antics when suggested by the hypnotist. 
To most individuals who have passed into the hypnotic condition, 
suggestions may be made of the most curious character, which 
will be carried out after the subject is awakened. It is a dis- 
puted point as to what extent a hypnotized person can be induced 
to do things, or commit crimes which are repugnant to his nat- 
ural moral sentiments. It is claimed by many that the moral 
sensibilities of the subject may be brought entirely under the 
domination of the operator, who can compel him to carry out 
criminal commands, though they be entirely foreign to his natural 
inclinations. Others contend that the hypnotist can put no new 
thought into the mind, but can only bring to the surface some- 
thing which is held therein. 

The exact condition of the brain and nervous system, of the 
organs of special sense and of mentality in the hypnotic condi- 
tion are not understood, although many of the professors (?) of 
hypnotism, who give public exhibitions, talk glibly of what it is. 
Hypnotism, in many respects, resembles somnambulism, cata- 
lepsy and trance, and we are doubtless justified in saying that 
in the hypnotic condition the highest mental functions are in 
abeyance and dissociated from the lower functions which they 
ordinarily control and direct, and that these lower functions are 
for the time under the control of the higher functions of another. 
In other words, in the normal, natural state a person controls 



778 DISEASES OF THE NERVOUS SYSTEM. 

or plays upon his own nervous instrument, in the hypnotic state 
another controls and plays upon it. 

The legitimate medical benefits to be derived from hypnotism 
are not as extensive as some enthusiasts have been led to believe, 
but in certain cases it may be made useful. There are many 
varieties and adjuncts of hypnotism. Many persons get certain 
ideas fixed in their minds by a process of auto-suggestion, that is, 
by taking up these erroneous ideas, as, for instance, regarding 
their own health, and dwelling upon them until they are firmly 
fixed in their mind, and can be removed only by counter sug- 
gestion when the mind is in a receptive condition. It is among 
this class of persons that christian scientists, mind healers and 
layers-on of hands work their seemingly wonderful and miraculous 
cures. 

The conscientious physician can and does often make use 
of counter suggestion, normal suggestion and mental impression 
to induce his patient to give up an absurd controlling idea and 
to swing back from the realms of fancy to the domain of reality. 
No doctor doubts that the mind has great control over the 
body. A patient with a buoyant, hopeful mind may recover 
health when mental depression, doubt and worry might turn the 
scale against him. A calm, hopeful person with a broken leg 
may get along much more comfortably and even more rapidly 
than a worried, discontented, restless one, but no amount of hope, 
resignation or faith can immediately reunite a broken bone. 
These facts indicate the benefits, bounds and limitations of mind 
healing, christian science, etc. Cases of hysterical paralysis, of 
disuse of limbs from mental inability to set them going, of imag- 
inary inability to eat, etc., may be cured by any process which 
makes sufficient impression to start the mental machinery in a 
new direction. So far, too, as any of these cures or faiths, or 
confidence in the physician, gives the patient hope and courage, 
to such extent may he be helped in overcoming acute curable 
disease, or buoyed up in sustaining chronic and incurable affec- 
tions. The claim that there is no such thing as disease and the 
claim of being able to treat and cure the self-same disease are 
sufficiently contradictory to show absurdity; but still more absurd 
is the claim, which I have heard made, that a devotee of faith 
healing could take deadly poison and not be harmed. 

Hypnotism may be successfully invoked in the cure of many 



DISEASES OF THE NERVOUS SYSTEM. 779 

morbid habits and states, but its range of usefulness is limited 
and the danger that may follow is not trivial. As exhibited in 
public by the traveling operator, or as practiced by the amateur, 
hypnotism is demoralizing and dangerous. Public exhibitions 
should be prohibited by law; neither should private exhibitions 
be allowed for other than scientific purposes and by persons fully 
competent, from observation and experience, to guard against 
misadventure. 

PARALYSIS AGITANS. 
(Shaking Palsy.) 

This is a disease which is especially prone to appear in the 
second half of life, the great majority of cases occurring after 
forty or forty-five, although it has been known in patients twenty 
or even twelve years of age. As its name indicates, it is char- 
acterized by muscular weakness and tremor and by muscular 
rigidity. It is not, properly speaking, an indication of senility, 
but rather of a functional derangement of the nerves. It is very 
often difficult to determine just when the disease began ; slight 
occasional tremors may exist for some time before the patient 
is aware of his real condition. It is not a very common disease 
and occurs with about the same frequency in the two sexes, 
probably slightly oftener in men than in women. In the causa- 
tion of shaking palsy heredity does not play an important part, 
but may be traced in a small proportion of the cases ; neither 
does station in life, nor occupation, have material influence. 

The exciting causes cannot be determined in more than one- 
third or one-half the cases, and when found vary much in char- 
acter, the most frequent being severe emotional shock, prolonged 
anxiety, injury and acute disease. 

It is well known that sudden alarm may cause trembling, 
which usually subsides when the alarm is over, but sometimes 
persists and may develop into this disease. A lady on a ferry- 
boat saw a baby spring out of its mother's arms into the river. 
Although the child was buoyed up by its clothing and soon res- 
cued, the lady who had been watching it was surprised to find 
on returning to the cabin that her upper lip was, as she expressed 
it, "going like a rabbit's." This proved to be the beginning of 
a typical paralysis agitans that culminated in death fifty years 
afterwards. The connection between the emotional shock and 
the subsequent palsy is not as a rule so marked as in this instance. 



780 DISEASES OF THE NERVOUS SYSTEM. 

A lady thrown from a carriage was not aware of any injury 
beyond a slight bruising, but in a few months began to feel a 
weakness in her left upper arm, when raising it to dress her hair. 
This weakness was soon accompanied by tremor which extended 
until all the muscles of the body were involved and a case of 
paralysis agitans developed. Dysentery, typhoid fever, exposure 
to cold and damp, etc., are also sometimes followed by shaking* 
palsy. 

The onset of this disease is generally very gradual ; occasion- 
ally it comes suddenly. As a rule some slight tremor is discov- 
ered in the muscles of the hands, limbs or face, and this, grad- 
ually increasing, extends to the muscles of all the limbs, the 
head, neck, face and tongue. When the disease becomes well 
marked the appearance of the patient is characteristic. The head 
is bent forward and stiffly held, the face wears an anxious expres- 
sion, the arms are slightly flexed so that the hands are brought 
near together in front of the body, and the fingers flexed so 
as to bring their ends against the ends of the thumbs; the knees 
are also somewhat flexed and the patient walks with a short 
shuffling step. Because of the tendency to stoop forward, thus 
bringing the center of gravity in front of the support, the patient 
has an inclination to go forward — sometimes so great that when 
started he cannot stop but passes into a shuffling run. 

The tremor is now almost always present but much increased 
when a voluntary muscular movement is attempted. This is 
well seen when the patient tries to feed himself and the rhythmic 
swaying of the hands becomes so great and persistent as to defeat 
the attempt. There is also contraction and painful rigidity of 
the muscles; and generally a tinge of color in the face which 
gives the appearance of health, but which is really due to vaso- 
motor paralysis, that is enfeeblement of the nerves which con- 
trol the amount of blood in the vessels. This condition is accom- 
panied by a feeling of fullness in the head, or dizziness, arising 
from the same cause. The mental faculties are not usually im- 
paired and persons have had this disease for forty or fifty years, 
yet retained all their natural mental vigor; but sometimes there 
is slight dullness, peevishness or irritability, or even decided men- 
tal deterioration. The patient may die at an advanced age, the 
palsy seeming to have scarcely any effect upon the duration of 



DISEASES OF THE NERVOUS SYSTEM. 781 

life, but in other cases the continued agitation has a decided influ- 
ence in wearing- out the patient. There are likely to be periods 
of increased trembling followed by remissions. During these 
violent periods the patient may become for a time entirely help- 
less, even comatose, which may lead the physician to fear imme- 
diate death. 

While the prospect of cure of this affection is not at all prom- 
ising, much may be done by proper treatment to improve the 
patient's condition and render him more comfortable. His en- 
ergy should be conserved by very late rising and avoidance of 
physical and mental fatigue. The diet must be nutritious and 
abundant, to which some constant but moderate alcoholic stim- 
ulant should be added. Tonics of various kinds to keep up 
the general tone of the system, together with bromides, hyoscine, 
galvanism, etc., to control the tremor. The patient should un- 
derstand that cure is not expected ; but that improvement can 
well nigh be assured, and also be informed that exacerbations, 
or bad turns, are to be expected, and must not be looked upon 
as necessarily indicating hopeless loss of control. 



CHAPTER VII. 

NERVOUS DISEASES OF GERM ORIGIN. 

There are three diseases of the nervous system which are of 
microbic origin, i. e., are caused by germs. They are diphtheritic 
paralysis, hydrophobia and tetanus. 

The first two have been considered under other headings, 
hence will only be briefly noticed here. Diphtheritic paralysis, 
as its name implies, follows diphtheria and is due to poisonous 
matter, developed by the bacteria of the disease, circulating in 
the blood and attacking the nerve tissues. The paralysis may 
affect almost any part of the muscular structure; may attack 
the muscles of deglutition, of the heart, or of respiration, and, 
while most cases recover, may prove fatal. 

Hydrophobia is another disease of the nervous system de- 
pendent upon specific microbic infection. There is very great 
popular misconception about hydrophobia. It is a rare disease 
and but a very small percentage of those bitten by dogs, that 
appear to be mad, are affected with it ; but many who are thus 
bitten are frightened into a state of nervous agitation, a spurious 
hydrophobia which may cause death. 

TETANUS. 

Tetanus, frequently called lockjaw, is an infectious disease, 
characterized by persistent spasm of the muscles and trunk, sub- 
sequently involving the muscles of the limbs. It may occur 
without any preceding disease, or it may follow an injury; the 
former being idiopathic, the latter traumatic. It is caused by 
a bacillus which is found in the earth, and sometimes in manure 
and other putrefying substances. The germs are likely to be 
introduced into punctured or contused wounds, especially of 
the hands or feet. The popular belief that a wound by a rusty 
nail or rough splinter from a floor is especially liable to be fol- 
lowed by lockjaw is not unfounded, for such articles are very 
likely to harbor the tetanus bacillus. The frequency with which 

782 



DISEASES OF THE XERVOUS SYSTEM. 783 

tetanus follows burns and other injuries from fireworks is due to 
the prevalence of its germs in the dust with which the hands, 
especially of children, become soiled while celebrating, and is 
rubbed by the sufferer into the smarting wound. The germs them- 
selves do not invade the blood and general system, but grow in 
the wound and there form a most virulent poison which circulates 
in the blood and thus sets up the nervous disturbance. 

When tetanus follows an injury it usually begins within ten 
to fifteen days. First there is slight stiffness about the neck and 
jaws, with difficulty in chewing; spasm of the muscles of these 
parts develops and the patient becomes unable to open his mouth, 
hence the popular name lockjaw. The spasms go on to involve all 
the muscles of the body, those of the back being most affected, so 
that during a spasm the patient takes the form of a bow and 
rests only upon his head and heels. Even between spasms the 
muscles are more or less stiffened, and the slightest irritation 
brings a recurrence of spasm. During the spasm the patient 
suffers great pain, but may not be able to speak. He is usually 
bathed in profuse perspiration. In some cases there may be 
scarcely any rise in temperature, in others the temperature runs 
very high. Death may occur from heart failure, or suspension 
of respiration during a paroxysm, or from general exhaustion. 

Tetanus is a very fatal disease. Hippocrates, who is called 
the father of medicine, and who wrote about 400 B. C, says: 
"The spasm supervening on a wound is fatal, and such persons 
as are seized with tetanus die within four days ; or if they pass 
these they recover." Indeed, at the present day the mortality in 
traumatic cases is eighty per cent, and in idiopathic cases, fifty per 
cent. 

Treatment. — To be of avail the treatment should be prompt 
and thorough, under the best obtainable medical advice. In trau- 
matic cases thorough excision and antiseptic treatment of the 
wound must be carried out ; the patient should be kept in a quiet, 
dark room, with a single nurse, and all sources of irritation excluded. 
The spasms must be controlled by chloroform, chloral, bromide of 
potassium, morphine, etc. When the lockjaw prevents ordinary 
feeding, food can be conveyed to the stomach by the nasal tube, 
or rectal injection can be used. Idiopathic cases require the 
same line of treatment, excepting, of course, that part which 
concerns the wound itself. 



784 DISEASES OF THE NERVOUS SYSTEM 

The greater number of cases of this dreadful disease could 
be avoided by promptly and thoroughly bathing all wounds 
liable to be infected, in a twenty per cent solution of carbolic 
acid, or some other effective germicide, then preventing further 
infection by wrapping the part in a clean cloth saturated in the 
same solution, the hands of the operator having first been cleansed 
by a careful washing in soap and water. It is not in the severity 
of the wound, but in its infection that the danger lies — a very 
slight lesion being sufficient to admit the germs. 

NERVOUS SYMPTOMS. 

There are certain nervous symptoms, common to different 
diseases, which are of sufficient importance to merit special though 
necessarily brief consideration. 

VERTIGO. 

Vertigo, or dizziness, means a sensation of loss of equilibrium, 
with momentary partial loss of consciousness. It may be caused 
by, or be a symptom of, several quite different disorders. The 
treatment will, of course, be the treatment of the disease of which 
it is a symptom. One of the most frequent causes of vertigo 
is that condition of the system called lithemia, a state in which 
the nutritive functions are deranged and the system loaded with 
effete matter. Lithemia is to be treated by remedies which 
stimulate proper nutritional change and free the blood from 
waste and imperfectly oxidized matter. Disease of the kidneys 
is an occasional cause of vertigo, which can be determined by 
proper examination of the urine, and treated by remedies directed 
to the restoration of the functions of the organs involved. 

Disease of the ear may cause vertigo, in some cases of a 
very severe type, which requires treatment suited to the char- 
acter of the ear disease. 

Eye strain, itself caused by muscular imperfection or defect 
in the apparatus for adjustment, sometimes causes vertigo. This 
condition should be remedied by operation, or by proper glasses, 
as required. 

A depraved state of the blood, or disease of the heart or 
blood vessels may cause vertigo by affecting the quality or quan- 
tity of blood supplied to the brain. Treatment should be directed 



DISEASES OF THE NERVOUS SYSTEM. 785 

to restoring the quality of the blood, or regulating the action of 
the heart, or improving the condition of the vessels. 

Both gout and the excessive use of alcoholic liquors are 
sometimes chargeable with vertigo. Occasionally vertigo is 
caused by various brain diseases. The popular idea, however, 
that vertigo is especially indicative of brain disorder is not cor- 
rect, and it is often a relief to patients to know this. Vertigo 
is also a symptom of locomotor ataxia, but is not common in 
other spinal diseases. 

So far as vertigo itself is concerned, the outcome depends 
a great deal upon the special condition of which it is a symptom. 
In lithemia it is frequently hard to overcome and may annoy 
the patient many years; for the lithemia itself is difficult to 
completely eradicate ; but it is annoying only, not serious. In 
acute kidney disease, especially in the young, the vertigo may be 
cured along with the disease itself ; but in chronic kidney disease 
the outlook is grave. The ear and eye cases are sometimes cura- 
ble, sometimes not, depending upon the character of the ear and 
eye diseases. Impaired condition of the blood can generally be 
cured and the vertigo with it. With vertigo, dependent upon 
alcohol, if the alcoholism can be cured and no organic damage 
has been done, the result is generally good- When vertigo is a 
symptom of brain disease, or spinal disease, the prospect is gen- 
erally serious. 

HEADACHE. 

Headache is a symptom of many forms of nervous disease, 
and is also very frequent in other diseases and disorders. Some- 
times the disease of which headache is a symptom is easily de- 
termined, and sometimes the headache is about all that can be 
made out. It is answerable for a large share of human suffering, 
and may vary from simply a disagreeable dull feeling to the most 
intense pain which can only be described as agony. It may be 
persistent for hours or even months, or it may be evanescent, 
lasting but a moment. It may be a continuous uniform pain, 
it may come in paroxysms, it may be intermittent or it may be 
throbbing. It may affect the whole head, or one-half of it, or 
be confined to a small area, or change from point to point. 
Sometimes the scalp may be very tender to the touch, and comb- 
ing the hair or any jarring of the head may greatly increase the 
pain. The eyes may be very sensitive to light, or vision may 

50 



786 DISEASES OF THE NERVOUS SYSTEM. 

be impaired and loud or even ordinary sounds may be very 
painful and exasperating. 

During an attack of headache the feet and hands, and fre- 
quently the general surface of the body, are likely to be cool, 
unless fever is present, and the head may be either cool or hot. 
The pulse may be rapid or slow ; the appetite lessened or in- 
creased, and eating may sometimes afford relief, but more 
generally increases the pain and is followed by vomiting. In 
some cases a person may continue both mental and physical exer- 
cise when affected with headache, in others either mental or 
physical activity so increases the suffering as to enforce the utmost 
quiet. Of the many forms of this disorder, the most important 
will be considered. 

Headache is a symptom of many of the brain and nervous 
diseases which have already been described, and as such the treat- 
ment is included in that of the respective disorders. Many 
nervous persons are much troubled by headache from overwork, 
mental or physical, from stress of care and responsibility, from 
worry, disappointment, etc. This is called nervous headache 
and may be almost continuous or come in paroxysms. When 
paroxysmal it may be severe and accompanied by intolerance of 
light and sound, sometimes by marked irritability, and occasion- 
ally by vomiting. In these instances it is much like sick headache 
but more preventable by hygiene and calmness. Nervous head- 
ache is most common in women and children of feeble constitu- 
tion who are poorly nourished. The treatment for this form is 
building up the health by improving digestion and nutrition 
and avoiding worry and nervous excitment. 

Headache is not uncommon from eye-strain, which itself 
may be due to astigmatism, distorted shape of the eyeball, un- 
equal action of the muscles or oversensitiveness of internal parts. 
For these conditions relief may be had from properly fitted glasses 
and rest. 

A very common form of headache is that generally known 
as sick headache. This form is more or less periodical, or at 
least recurrent. Many persons, about equally divided as to sex, 
are subject to attacks during all their lives and the disorder is 
markedly hereditary. The manner in which the attacks come on 
differs in different persons, but in each patient it generally begins 
every time in the same way. The pain may affect one or both 



DISEASES OF THE NERVOUS SYSTEM. 787 

sides of the head, may change from side to side, be general 
over the head or confined to the forehead, temples or base; it 
may come on at any time of the day and may be preceded by an 
unusual appetite. After several hours there may be vomiting 
and relief, or after emptying the stomach the pain may not sub- 
side until the patient has slept. When he awakes the pain and 
distress will usually be gone and only a feeling of soreness remain 
for a few hours. The vomited matter consists of undigested food 
and mucus. Some persons rarely vomit, some do with nearly 
every attack, while with others vomiting is repeated many times 
with great nausea and the bringing up of bile. 

The victim of sick headache is very likely to think the attacks 
due to indiscretions of diet, of eating at irregular times, or hur- 
riedly, or when the mind is intensely occupied, etc. ; but while 
careful attention to regular habits in this direction will lessen 
the frequency and severity of the attacks, it will not altogether 
prevent them. The real difficulty lies in the peculiarly susceptible 
nervous organization. 

Another form of headache is caused by acute indigestion. 
It is usually severe, of a "snapping" character, coming on sud- 
denly after overeating or freely partaking of indigestible food 
and alcoholic drinks. Indeed, this is the headache which follows 
banquets and wine suppers. Because of the nausea and vomiting 
which is likely to go with this headache, it is frequently called 
sick-headache, but it is very different from the proper periodical 
sick-headache. Headache from acute indigestion is generally re- 
lieved soon after the stomach has been unloaded; the vomiting 
is often accompanied by diarrhea — a real cholera morbus. 

With some persons whose digestion is weak and whose 
nervous system is easily perturbed, slight errors or excesses may 
bring on the headache of acute indigestion; others can eat and 
drink almost anything without inconvenience. Certain dyspep- 
tics have very frequent, sometimes daily, headache, accompanied 
by dyspeptic symptoms, coated tongue, acid stomach and con- 
stipation. The headache may be felt at waking in the morning 
and disappear during the day ; or it may come on in the after- 
noon and disappear at night. As a rule this headache does not 
interfere with ordinary duties, but occasionally an unusually severe 
attack will be disabling. 

Malarial headache depends upon malarial poison, and comes 



788 DISEASES OF THE NERVOUS SYSTEM. 

in paroxysms with the regularity of ague. It is generally con- 
fined to one side of the head, comes suddenly, is very severe for 
a few hours and passes away leaving a feeling of soreness. 

Headache is a frequent accompaniment of anemia and great 
debility, and in intense cases is almost constant. When the 
patient is in a state of rest both of body and mind the headache 
may disappear, only to recur on the least bodily or mental exertion. 

GENERAL TREATMENT OF HEADACHE. 

In the treatment of headache the first thing is to determine 
what causes it, and the next to remove or correct such cause. 
This may be a comparatively easy matter, or a very difficult one. 
If the headache depends upon acute disease, fever, rheumatism, 
pneumonia, etc., the proper treatment of such acute disease may 
be all that will be required for the headache, or remedies 
may be needed which will directly lessen the pain. 

For the headache of eye-strain, use proper glasses fitted 
by a competent oculist. In brain diseases, and some nervous 
diseases, the headache "symptom depends directly upon the impli- 
cation of the nervous tissue. Here, too, will often be required 
not only the general treatment of the brain or nerve disorder, 
but the painful symptoms will require the use of remedies to 
overcome or soothe the pain, as an opiate or other anodyne. 

Malarial headache will best be treated by full doses of quinine 
till the periodicity is broken up, then strengthen the system with 
iron, arsenic, strychnia, etc. 

When headache depends upon anemia, the blood must be 
restored to a healthy condition. This is often a difficult task, 
for the anemia may be caused by disorder of the stomach, by 
exhausting discharges, by impaired action of certain glands, by 
derangement of the blood-forming apparatus, etc. The discov- 
ery of the ultimate causation of anemia and its treatment is a 
problem to be solved only by a skillful physician. 

In the treatment of nervous headache — the headaches of 
acute indigestion and of dyspepsia, sick-headache and the at- 
tacks of other recognized and unrecognized varieties — there is 
considerable scope for hygienic and preventive measures, for the 
lessening of discomfort by domestic remedies and for nursing, 
as well as for the curative treatment of the physician. Between 
the attacks efforts should be directed to lessening the tendency 



DISEASES OF THE NERVOUS SYSTEM. 789 

to recurrence and extending the intervals between them by im- 
proving the general condition of the system and bringing it up 
to a high standard of vigor. In the established periodical head- 
aches it is generally impossible to entirely prevent them, though 
much may be done to render them less frequent and less severe. 
Those subject to constitutional headaches are in a condition below 
the normal standard, and a regulation of diet, exercise and habits, 
with suitable medicines to keep the excretions active and to stimu- 
late and tone up the system, will strengthen the powers of re- 
sistance and increase the intervals between the attacks and render 
them lighter. To this end defects in hygienic surroundings and 
influences should be thoroughly corrected, requiring, it may be, 
a complete change in location or business, often difficult or im- 
possible to accomplish. Much may be done by the patient if 
he will courageously and systematically correct his diet by dis- 
carding pastry, indigestible foods, stimulants, tea and coffee. The 
latter is often looked upon by these patients as a necessary 
nerve tonic, when in fact it is the reaction following its stimula- 
tion which really causes the headache. The victim of sick-head- 
ache should, under judicious advice, abandon the articles of food 
and drink at all likely to produce nervous disorder, and limit 
his diet to the most easily digested foods, and to those especial 
articles which careful experiment shows to be best fitted for 
him, for to some extent each case is a law to itself. 

It follows with even greater force that one who is subject 
to the headache of acute indigestion caused by wine suppers, 
cloying refreshments served at parties, or even wholesome food 
taken out of season, should carefully avoid what, to him at least, 
are baneful excesses; while the habitual dyspeptic should strictly 
regulate the quality and quantity of his food, as well as the time 
of taking it. Dyspepsia may be caused by monotonous or coarse 
foods, or by a diet not generally objectionable but not adapted 
to the individual. A hasty plate of oatmeal in the morning 
and an inadequate lunch, postponed by business, may bring the 
patient to his evening meal with a headache, exhaustion and 
nervousness which well nigh preclude eating; the dyspepsia 
of insufficient nutrition ere long leading to complete break- 
down. Such dyspepsia may be cured by a generous beefsteak 
with toast slowly eaten in the morning, a nourishing lunch at 
a regular hour in the middle of the day, and a hearty but digestible 



790 . DISEASES OF THE NERVOUS SYSTEM. 

meal when the day's work is done. Cooks, by continual eating, 
often develop dyspeptic headache, and servant girls acquire dys- 
peptic anemia from limiting their meals to "tea and bread," 
conditions to be respectively cured by regularity and a generous 
mixed diet. Emotional and nervous excitement is very likely 
to precipitate an attack of headache, and those who are subject 
to this malady should cultivate self-control and uniformity of 
temper. 

The medical requirements will be met by bitter tonics, bark, 
nux vomica, quinine, iron, gentian, etc., in various combinations. 
Most patients are constipated and the bowels should be moved 
once daily by gentle agents suited to the particular case. Various 
mineral waters, or salines in hot or cold water, before breakfast, 
phosphate of soda as a liver stimulant, or aloes, rhubarb, podo- 
phyllum laptondrin, in various combinations, with strychnia or 
belladonna, may be used according to the nature of the case and 
idiosyncrasy of the patient. The preparations of cascara sagrada 
(sacral bark) are most excellent in relieving chronic constipa- 
tion. While violent purgation by large doses of "salts," pills, 
etc., is decidedly injurious, suitable combinations to persuade the 
bowels to a daily movement may be taken indefinitely without 
harm. 

When symptoms of an approaching attack are felt, there is 
a wide difference as to what can be done to ward off or mitigate 
it. If the attack depends upon acute indigestion or simply fol- 
lows a hearty meal, prompt evacuation of the stomach by warm 
water and mustard, or by ipecac, or by a hypodermic injection 
of apomorphia, followed if need be by movement of the bowels 
and a nervous sedative, may cut short the pain. 

In the nervous and periodical varieties seclusion in bed in 
a quiet dark room, with a cooling lotion or tight band on the 
head, sleeping if possible, and abstaining from food, may abort 
the attack. With others a hearty stimulating meal may do better. 
Gentle exercise is sometimes favorable ; violent exertion is almost 
always unfavorable. When the extremities are cool a hot mus- 
tard footbath for an hour or more will be very useful and com- 
forting. Certain nervines may ward off an attack, as guarana, 
one of the bromides, valerian, caffeine, etc. For a person not 
accustomed to using them a cup of strong coffee, or an alcoholic 
stimulant, spirits of chloroform, etc., may be helpful. These reme- 



DISEASES OF THE NERVOUS SYSTEM. 791 

dies must, however, be taken before the stomach becomes too 
irritable to retain them. Indeed, sometimes they are entirely 
useless except as an emetic. 

If the attack has fully set in, efforts must be restricted to 
lessening its severity and shortening its duration. Sometimes noth- 
ing will be of any particular benefit and the attack must simply 
be allowed to wear itself out. In others some relief can be had 
by hastening the evacuation of the stomach and bowels by emet- 
ics and injections, by rest and quiet, by freedom from light, sound 
and mental action, by heat to the extremities and cooling lotions 
and pressure to the head — such measures as have already been 
mentioned. In a few cases hot applications to the head are grate- 
ful. When the stomach is irritable sleep can be procured by the 
use of chloral in a rectal injection; this is especially serviceable 
in children. After the stomach is emptied, nausea may be allayed 
by very hot water, aromatic spirits of ammonia, spirits of chlo- 
roform, etc. Opium and its preparations should be avoided, 
because they often disagree, and because of danger of promoting 
the opium habit. 

INSOMNIA OR SLEEPLESSNESS. 

Inability to get proper sleep is an annoying and ever serious 
condition. Inasmuch as the physiology of sleep is not well un- 
derstood, insomnia must be studied in connection with the con- 
dition by which it is caused, and its treatment will vary according 
to its causation. It may be caused by worry, anxiety, grief, etc., 
and in this form is often very intractable. It requires a good 
deal of tact and judgment on the part of the physician to deter- 
mine how much dependence should be placed in drugs and how 
much in hygiene and diet. Indeed, where there is chronic busi- 
ness anxiety, or family or personal worry, it may be impossible 
to overcome the insomnia until the cause is abated. Sleepless- 
ness from pain may depend upon neuralgia or neuritis, the first 
stage of certain inflammatory diseases, as pleurisy, pneumonia, 
peritonitis or rheumatism, or upon eye diseases, influenza and 
sundry brain affections. 

Treatment. — The first step in treatment of insomnia due to 
the pain of acute disease is to properly treat the disease which 
causes the pain and to ascertain how much such treatment may 
relieve the sleeplessness. If the insomnia still continues the 



792 . DISEASES OF THE NERVOUS SYSTEM. 

hypnotics — chloral, sulphonal, trional, etc. — may be used alone or 
with bromide of potassium. 

Fevers are frequently attended with sleeplessness, for which 
bathing, food and stimulants should be tried ; if these are not suc- 
cessful, bromides and more active hypnotics may be needed. Nerv- 
ous prostration is often accompanied with sleeplessness for which 
attention to diet, rest, general hygiene and simple quieting meas- 
ures will be preferable to "sleeping medicines." The sleeplessness 
of incipient melancholia is often one of the first symptoms of that 
disease and the treatment is that of melancholia. 

A very common cause of sleeplessness is the use of tea, coffee, 
tobacco, alcoholic drinks, disagreeable foods, etc. It is very 
commonly recognized that many persons cannot drink coffee at 
night without lying awake afterward, but strong coffee in the 
morning only will prevent some persons from sleeping well. 
Some susceptible individuals may be rendered sleepless by tobacco, 
some by certain wines or liquors, others by particular foods. 

The use of dumb bells, Indian clubs, or any form of vigorous 
exercise which quickens the circulation, thereby drawing the ex- 
cess of blood from the brain, often quickly induces sleep in those 
suffering from study or too much mental work. 

For sleeplessness attributable to errors in diet or drink, such 
errors must be corrected. When due to nervous restlessness 
without manifest disease, certain expedients may be useful. A 
warm bath, or in some cases a cold bath, at bedtime will materially 
,aid in procuring sound sleep. Some persons sleep best after a 
very light supper; but the old-fashioned idea that one should go 
to bed hungry is often misleading. Many persons in fairly good 
health, others who are weakly or nervous, and many in in- 
cipient or even in settled melancholia, will sleep better for taking 
some light stimulating food at bedtime, like hot milk, milk and 
egg, egg-nog, etc. 

Bathing, regulation of diet, exercise, avoiding disturbing in- 
fluences and even food on retiring, may be tried as home remedies 
in simple sleeplessness, but if not successful the physician should 
be consulted. In acute diseases, fevers, etc., very little should be 
attempted, except under the direction of the medical practitioner. 
It is a most pernicious practice for one to attempt to doctor himself 
for chronic sleeplessness ; dangerous drug habits are often acquired 
by so doing. 



DISEASES OF THE NERVOUS SYSTEM. 793 

COMA. 

Coma, a state of unconsciousness, is attendant upon several 
diseases which require immediate medicai attention, and will re- 
ceive only brief enumeration. The treatment will depend upon 
the condition which causes the coma. 

Injury may produce either slight and brief, or very profound 
and prolonged coma. The injured person should be placed upon 
a bed in as comfortable position as possible, and prevented from 
getting chilled, and bleeding should be controlled by pressure 
until the arrival of the physician. Coma is one of the symptoms 
of disease of the kidneys. The victim of chronic kidney disease is 
likely to die comatose. Alcoholic liquors in excessive quantity 
will produce alcoholic coma, which ordinarily will pass away in 
a few hours, requiring only watching, protection from cold, or 
sustaining of the strength ; but it may prove fatal. 

Coma is also a symptom of brain hemorrhage — atrophy as it 
is usually called — and of other brain diseases, which will require 
the prompt attention of the physician, the patient receiving mean- 
time the customary friendly ministrations. Coma, from any 
cause, shows a profound impression on the nervous system and 
must always be regarded as a serious symptom. 

FAINTING. 

Fainting is a temporary loss of control of the mental and 
bodily functions. In any case of fainting the patient should im- 
mediately be placed in a horizontal position in a draught of fresh 
air, and all tight clothing about the throat, chest and waist loos- 
ened. In many cases this will be all that will be required to re- 
store consciousness, but if the restoration does not come very 
soon, cold water may be dashed into the face and upon the chest, 
and the extremities briskly rubbed to aid the circulation. A 
dinner plate may be dipped in hot water and quickly applied to 
the stomach, care being taken not to burn the patient. Too liberal 
use of ammonia, or other smelling salts, may do harm. 



INSANITY. 

By B. D. Eastman, M.D. 

In some of the lower animals the several parts of the organism 
differ but little in structure or in function ; but as we look higher 
in the scale we find the various parts of the body differing more 
and more, both as to anatomical structure and physiological func- 
tion, until in man we see the widest differentiation and the most 
complex function ; the various organs of the body each having in- 
dividual offices to perform in the complicated association of 
phenomena called life. 

The function of the stomach and digestive apparatus is to 
digest food and furnish nutrients to the tissues ; that of the heart 
and blood vessels, to circulate the blood ; that of the eye, to give 
vision, etc., but the most important and distinguishing attribute 
of man is the function of mentality carried on by the brain, espe- 
cially by the superficial gray matter called the cortex. When 
the stomach and digestive apparatus are sound we have good di- 
gestion ; if the heart and vessels are in good order we have good 
circulation ; if the eye is normal there is distinct vision, and when 
the brain is sound we have healthy mentality or sanity. Indiges- 
tion, imperfect circulation, indistinct vision and insanity are re- 
sults of diseased conditions of the respective organs, but these dis- 
eases do not necessarily imply entire annihilation of these func- 
tions. A good deal of indigestion is not incompatible with a long 
and useful life, but if the stomach be sufficiently diseased, its func- 
tion will be entirely suspended and death will soon result. So, 
too, insanity does not necessarily end all mentality, and insane per- 
sons may live many years with their mental faculties deranged, 
but not destroyed ; or, on the other hand, the brain disease which 
causes insanity may be so serious as to lead to a speedy death. 

There is, however, a very important and wide-reaching pecu- 
liarity of disease of the brain wherein it differs from derangement 
of any other organ. Our mentality is that which distinguishes us 
from the brute creation, establishes our relation to each other and 

795 



796 , INSANITY. . 

to our environment, defines our individuality, and constitutes our 
personality — the "ego ;" and as the brain is the organ of mentality, 
it follows that disease of this organ may change any or all the 
manifestations of the ego, not only in its relation to others and 
to environment, but in relation to itself. It matters not, in con- 
sidering psychological problems, whether this ego be called soul, 
mind, matter or function ; all the knowledge we have of it is 
through its manifestations, developed only through the action of 
the brain. It is sufficient to know that a diseased brain causes ab- 
normal manifestations of the ego — the deranged mentality which 
is insanity. 

To avoid confusion it should be mentioned here, that the brain 
has various departments and functions, as has been especially 
noted in a previous chapter. Serious, even fatal diseases of the 
brain may exist without attacking that part of the organ con- 
cerned in mentality and without producing insanity; besides, not 
every disturbance of mentality is termed insanity, but only such 
interruptions as last a considerable time. The delirium of fever 
and the incoherence of drunkenness are not considered varieties of 
insanity, although they may not essentially differ from it. 

Insanity is a condition to be described, and one that cannot 
be satisfactorily defined, but it may be well to give such a definition 
of it as in a few words will most clearly convey to the non-profes- 
sional reader its meaning. For this purpose insanity may be said 
to be morbid mental manifestations dependent upon disease of the 
brain. 

That the reader may have a clear understanding of this sub- 
ject, we will specify some conditions which are sometimes incor- 
rectly considered as phases of insanity. Eccentricity is one of 
them. Not a few persons have during all their lives very peculiar, 
queer, but inoffensive ways of talking and acting — ways that are 
natural to the individual. These peculiarities in these persons do 
not constitute insanity. Other individuals have vicious, danger- 
ous, criminal tendencies which are habitual and natural ; these are 
not insanity. But if a person who has always been in the habit of 
talking and acting in the ordinary conventional way common to 
his rank and station in life, changes in this respect and talks and 
acts in a manner unusual and unnatural to him, it at once arouses 
the suspicion that he is insane. So, too, conduct that in one sta- 
tion in life is usual and natural, would, in some other stations, be 



INSANITY. 797 

very unusual and unnatural, and presumptive evidence of insanity. 
It is common for the Hindoo mother to throw her child into the 
Ganges, a custom that indicates grossly perverted ideas, but not 
insanity. On the other hand, if an ordinarily happy, intelligent 
American mother drowns her child, it is strong evidence of mental 
derangement. 

Thus, there are two general methods by which the question 
of insanity may be determined : The first is by comparing the 
person with his former self, the second, by comparing him with 
what is customary in his station in life. If, therefore, a person 
is found to have 1 changed mentally from what is natural to him, 
or, provided his former personality is not known, he is found 
talking and acting in a manner not compatible with his station in 
life (sufficient moral causes, and the immediate effects of sickness 
and drugs being eliminated), such change or incompatibility is 
presumptive evidence of insanity. In applying the foregoing rules 
it is always important to exclude the conditions cited as excep- 
tions. The arousing of religious sentiments may cause complete 
change in a dissolute person, or getting into bad company may 
change an honorable, law-abiding individual into a reckless crimi- 
nal, yet in neither instance, could the person be called insane ; but 
similar change without any adequate external cause would indicate 
insanity. The acute delirium of fever, or other disease, and the 
immediate effect of alcohol and other poisons, may induce a men- 
tal condition which is essentially the same as that of insanity, still 
as such a state is temporary and directly due to toxic agents, it is 
not classed as insanity; but the effects of disease of other organs, 
or the habitual use of alcohol or other drugs, may bring about a 
serious and continued brain disease, causing that more permanent 
mental derangement called insanity. 

The disease of the brain which causes insanity may assume 
two fundamental forms: (i) Defective development. (2) Disease 
subsequent to development. 

The development of a human brain -structure and brain power 
is a marvelous phenomenon, which distinctly marks the wide dif- 
ference between man and the brute. Of the lower animals the 
young come into existence with the brain and brain-power fully 
developed, or complete development takes place within a very 
short time; thus, the chick upon leaving its shell immediately be- 
gins to run about, to seek food and to care for itself. It is possessed 



798 . INSANITY. 

of all the brain power it will ever have; there is no further 
brain development for it, and it can never accomplish anything 
more than its parent has done. But the infant is born with a brain 
incompletely developed physically, and without mental power. It 
is stimulated to the act of sucking, by reflex nervous excitation, 
when anything is placed between its lips, but it is only by a process 
of education that it learns to walk, to care for itself, to provide its 
food, or to equal or perhaps surpass its parents in accomplish- 
ments. The period of brain development is very much longer in 
the child than in the chick, both before and after birth, and the 
physical and functional development, infinitely more complex. 
This great complexity of the human brain and long period of de- 
velopment render imperfection or arrest of the process very fre- 
quent with resulting disorder of function ; hence insanity from de- 
fective brain development. The complicated structure of a fully 
developed brain, its constant activity, the frequency with which it 
is overtaxed, and the stress put upon it by transgressing the laws 
of health, physical, mental and moral, render it especially liable 
to physical disorders from which follows insanity from disease of 
the brain. 

Insanity from either of these causes assumes different forms, 
and it will aid us in their consideration to group them in a simple 
and natural way, as follows: 

. . ( Idiocy. 

Insanity caused by defect in brain J Imbecility. 

development. ( Feeble-mindedness. 

f Melancholia. 
Mania. 
Insanity caused by brain disease J Paranoia 



after development. 



Dementia. 
Paretic Dementia. 



Idiocy, imbecility and feeble-mindedness are but different de- 
grees of the same general condition. The brain defect to which 
they are due may be congenital or acquired. In the congenital 
cases, proper brain development is lacking, the child having been 
born with the brain more or less, imperfectly formed, or even lack- 
ing in important parts. In such a case it is plain that the normal 
development of the brain, which should go on during infancy and 
childhood, is impossible, and that the subject of congenital brain 



INSANITY. 799 

defect must always remain defective mentally. In acquired cases, 
the brain at birth has reached its then normal condition, but injury 
during the birth process, or accident or disease during early child- 
hood, damages the brain structure and prevents subsequent nor- 
mal mental growth. 

There is no material difference in ultimate results between 
congenital and acquired defects of equal extent. In the most pro- 
found cases of idiocy there are practically no mental manifesta- 
tions; only the vegetative, organic and simpler nervous functions 
exist. The child performs only automatic actions and is a very 
pitiable object. The higher grades of idiocy frequently exhibit, in 
certain directions, a good deal of memory and astuteness. They 
are often fond of music and may be extraordinary natural musi- 
cians, learning by ear and repeating by note intricate composi- 
tions, but they never become intelligent musicians. Blind Tom, 
the negro boy, exhibited a few years ago as a prodigy, was an ex- 
aniple of the musical idiot. 

By gradual steps idiocy passes into imbecility, and imbecility 
into feeble-mindedness, in the higher grades of which there is only 
slowness of development, backwardness and slight lack of mental 
capacity. 

The causes of all these forms are varied. In congenital cases 
the immediate cause is arrest of development, but what underlies 
such arrest is not well understood. Heredity counts for much, 
and in certain families these defections are very common. Indeed, 
one of the best authorities says : "Idiocy is of all mental derange- 
ments the most frequently propagated by descent." Not unfre- 
quently the heredity is not traced to the same condition in the 
parent, but to insanity, intemperance, epilepsy and other neuroses. 
Sometimes parents who seem to be untainted by any imperfection 
will have a series of more or less idiotic children from some unex- 
plained incompatibility or incapacity for perfect reproduction. 
There is a widespread belief that consanguineous marriages are 
among the most common causes of idiocy and imbecility. In the 
popular mind the marriage of cousins is almost sure to beget 
idiocy; but the consensus of the best medical opinions is that con- 
sanguinity alone has very little to do with the production of idiocy. 
If the stock be sound and healthy in body and mind, cousins may 
marry without extra risk, but the real point is, that when near re- 
lations marry, any family tendency to physical or mental weakness 



800 , INSANITY. 

is greatly increased, because of the same influence from both 
parents; hence if the members of a neurotic family intermarry, 
the prospect for the offspring- must be bad. 

It occasionally happens that an infant's brain is injured by ex- 
cessive pressure or by internal hemorrhage during birth, which 
leads to arrest of development. Meningitis, convulsions, epilepsy, 
hydrocephalus, infantile palsy and injury to the brain by fall, blow 
or other means, are the principal causes of acquired idiocy and 
imbecility. 

As a rule neither medical nor surgical treatment of idiocy, im- 
becility or feeble-mindedness is of any avail. It is obvious that 
congenital brain defects cannot be remedied, but careful medical at- 
tention may prevent disaster to the brain, and prompt operation in 
some cases of injury to the head may prevent brain complications. 
In a few cases the relief of pressure by operation on an unyielding 
skull has proved beneficial. In most cases of defective mental de- 
velopment treatment is restricted to taking the best possible care 
of the patient, and is divided into two departments — the custodial 
and the educative. For the lowest classes the custodial feature is 
the most important; for the least defective the educational fea- 
ture is of the most value. 

The presence of an idiot or imbecile is a great detriment to 
the welfare of a family, and with increasing strength and develop- 
ing propensities he may become a menace to the family and the 
neighborhood. The impossibility in an ordinary family of giving an 
jdiot or imbecile proper control, protection and education, ren- 
ders it best that such defectives be cared for in an institution 
especially designed for such cases, where experienced and com- 
petent custodians and teachers are provided. The amount of edu- 
cation which they are capable of acquiring varies greatly, some 
being able to make scarcely any improvement, while others can 
be made self-supporting. At the other extreme of these defectives 
are the feeble-minded or backward children, some of whom do not 
appear to be abnormal, excepting in their backwardness — a youth 
of ten or twelve may show only the capacity of a child of five or six. 
In an ordinary school these children are annoyed and embarrassed 
by being classified with their juniors, and are therefore best edu- 
cated in special schools. 

In some cases mental development is defective because de- 
privation of one or more of the special senses closes the usual 



INSANITY. 801 

gateways of knowledge, and that part of the brain which carries 
on mental operations remains more or less inactive from lack of 
mental stimulus. This is called idiocy by deprivation, and has been 
likened to a seed which does not sprout because kept away from 
sunlight and moisture. 

The cases of Laura Bridgman and Helen Keller, in whom all 
senses but that of touch, were destroyed by disease in early child- 
hood and who were educated through this one remaining sense, 
show what patience and perseverance can do in early life ; but if 
these cases are neglected till habits are formed little can be done 
for them. 

We now come to the consideration of our second group : 
Insanity caused by brain disease after development. 

Although insanity properly includes the mental manifesta- 
tions of brain defect as well as brain disease, it is this second 
group to which the term insanity is usually applied. In this group 
of mental diseases there has been normal brain development and 
corresponding mental capacity, but disease has attacked the brain, 
it can no longer properly carry on its function, mentality, and the 
result is deranged brain function or insanity. 

ILLUSIONS, HALLUCINATIONS AND DELUSIONS. 

Before considering the different forms of insanity, it is de- 
sirable to explain certain terms used to designate some of the 
symptoms of mental derangement — illusion, hallucination and de- 
lusion. These terms, often confounded, have in mental medicine 
distinct and different meanings. An illusion is a false interpreta- 
tion of an object actually present ; an hallucination is a false percep- 
tion of an object which has no real existence; a delusion is a false 
belief. 

Any one of these forms of erroneous sensori-psychic activity 
may exist in a state of perfect sanity. The circle of fire seen when 
a burning stick is rapidly moved in a circle is an optical illusion, 
due to the physiological fact that an impression made upon the 
retina of the eye remains for a brief interval of time after the 
stimulation ceases; interpreting the moaning of the wind to be 
voices or noises of animals, is an example of auditory illusion. 
Hallucinations in health are most likely to occur in that half- 
sleeping state we call dozing, or in reverie, or when the mind, as 
of the artist or musician, is intensely occupied in its favorite study. 

51 



802 INSANITY. 

Hallucinations are common in ordinary disease. A lady, when a 
little run down in health, always saw, upon a certain stair, a black 
cat which was soon banished by a course of tonics. A fever pa- 
tient who had been furnished that "never failing'' hypnotic, a hop 
pillow, saw two of his neighbors bring into the room a hop pillow 
so large it would scarcely go through the door. As long as the 
mind corrects the abnormal sense-impressions, or estimates them 
at their true value, they are not indications of insanity, and do not 
lead to the false belief termed delusion. Indeed, many sane per- 
sons hold delusions which are due to faulty education, prevalent 
errors, station in life, etc. ; but when, because of brain disease, 
the mind is unable by reason and judgment to correct illusions or 
hallucinations, they become evidences of insanity, and the belief 
in their reality constitutes insane delusions. 

Delusion has already been defined as a false belief, and when 
such false belief is due to disease it becomes an insane delusion — or, 
as generally used in connection with insanity, simply delusion. 
It is the symptom of insanity which most strongly appeals to the 
ordinary observer, and was formerly thought to be essential to 
insanity; but although insane persons do not always manifest de- 
lusions, when a person claims to be emperor of the world, Jesus 
Christ or God, such delusions are striking symptoms of the mental 
disorder. 

MELANCHOLIA. 

Melancholia is a form of insanity in which there is great men- 
tal depression or melancholy, with depression of the bodiry powers, 
mental distress, and often accompanied by suicidal impulse. 
Melancholia shows itself in four typical forms — (i) simple melan- 
cholia, (2) agitated melancholia, (3) hallucinatory melancholia, (4) 
stuporous melancholia. 

Simple melancholia, in its mildest form, appears very much 
like an ordinary depression of spirits, but the facial expression 
of mingled woe, shadowy mental dullness and distrust, is so char- 
acteristic as to be readily recognized by an expert. Intimate 
friends and relatives will detect something unusual in the patient, 
but may not be able to explain in words the changes. The usual 
sources of pleasurable sensation, such as family associations, busi- 
ness responsibilities, accustomed recreations, pleasing sights, 
sounds, odors, etc., become causes of mental distress and pain. 
Every sensory impression, which in health would give pleasure, is 



INSANITY. 803 

distorted by the deranged brain into something distressing and 
mournful. Hence the patient evinces no pleasure in anything, 
and can scarcely be induced to smile. There is also obstinate sleep- 
lessness and a dull aching pain in the back of the head and neck ; 
the memory is not usually impaired and the occurrences of the 
melancholy period can generally be recalled. Most cases of simple 
melancholia are without hallucination or illusion. 

In hallucinatory melancholia the melancholy is much more 
marked. In addition to painful mental sensations, the patient has 
distressing hallucinations and illusions. Every sensory impres- 
sion from the organs of special sense, and from every part of the 
body, are converted into terrorizing hallucinations and illusions. 
Delusions of an introspective and self-accusative character take 
possession of the patient, and he bemoans his imaginary undoing. 
These patients have the delusions that they have nothing to hope 
for, that they are excessively wicked, that they ought not to eat, 
that their food is mixed with poison or the most noxious and 
offensive filth, that the meat given them is human flesh, that they 
will bring misery upon their friends, that they have committed the 
unpardonable sin, etc. They also have delusions of personal in- 
jury, that they are to be tortured, and the like. One of my patients 
had the delusion that a circular brick room, like a cistern, with 
several openings in the sides, was being built as a place of tor- 
ture for her; that she was to be placed therein, and that heated 
irons were to be thrust through the holes into her person. Indeed, 
the variety of delusions which are entertained by melancholiacs is 
well nigh limitless. The fear of personal injury, the apprehension 
of bringing disaster upon relatives and friends, the load of imagi- 
nary crime, and the belief of utter spiritual hopelessness, frequently 
causes the patient to become excessively and almost constantly 
agitated, constituting the third form of this disease, agitated 
melancholia. These patients are almost constantly agitated, wring- 
ing their hands, throwing themselves about, crying out, bewailing 
their fate, incoherent, and perhaps violent. 

In stuporous melancholia the patient becomes inattentive, 
mute and motionless early in the disease. The mental powers 
appear to be benumbed by the terror which has seized upon him. 

There are certain important characteristics which appertain 
more or less markedly to all forms of melancholia and deserve brief 
consideration. These are insomnia, post-cervical ache, precordial 



804 INSANITY. 

fear, loss of weight, violent outbreaks, suicidal and homicidal tend- 
encies. 

Insomnia (sleeplessness) is almost always a precursor of and 
an attendant upon melancholia of any form, and is very commonly 
one of the earliest preliminary symptoms. In some cases it is al- 
most complete and is frequently very obstinate. 

The post-cervical ache is a dull, heavy, ill-defined, variable, 
aching pain in the back of the head and neck, and is generally 
present in the simpler cases of melancholia. Precordial fear is a 
feeling of apprehension or fear, referred to the breast over the 
region of the heart. This is a reflex nervous phenomenon, and 
is similar to the feeling which any frightened person has in this 
region. These two nervous phenomena are more noticeable in the 
simple cases than in those of greater severity. 

The general impairment of the vital forces in melancholia 
causes derangement of the function of digestion and assimilation 
and leads to interference with nutrition and loss of weight, which 
is sometimes very great. In acute cases, increase of weight is a 
very encouraging indication; but in some chronic cases accom- 
panied by loss of mental power (dementia) increase of weight oc- 
curs without mental improvement. In most cases of melancholia, 
especially those affected with precordial fear, there is liability of 
violent outbreak. The feeling of apprehension, fear of personal 
injury, etc., becomes so great that the patient seeks to save him- 
self, or revenge himself, or blindly gives way to aimless violence. 
The most quiet and apparently apathetic case may become vio- 
lently excited in an instant and prove very dangerous. 

The logical outcome of morbid mental depression is suicide. 
The victim sees no respite from his tortures, no relief from his 
sufferings, and his thoughts naturally turn to escaping his trou- 
bles by ending his life. This danger is always imminent in all 
cases of melancholia, even of the mildest sort. It is extremely diffi- 
cult to make the friends of patients appreciate this. Not only is 
there danger of suicide, but of homicide as well. The daily papers 
frequently record instances of a whole family being killed by a 
parent who then takes his own life, although not previously con- 
sidered sufficiently insane to be sequestered. In general, the under- 
lying idea is some phase of the delusion that it is better to put the 
whole family out of the way than to let them live to suffer. A 
very worthy Christian woman in profound melancholia tried to 



INSANITY. 805 

kill her attendant. After recovery she clearly remembered the 
chain of reasoning, which impelled her to the act. She thought 
that as long as she herself lived she would bring sorrow, sin and 
shame to all around her, and that she would be doing less harm 
and committing less crime by taking her own life, even if she 
had to kill her attendant to accomplish it. 

Simple melancholia, in many cases at least, seems to be a 
self-limited disease, i. e., one that after a time tends of itself to 
recovery. This may take place in three months, or in twelve or 
eighteen. Other cases which at first seem to be simple, develop 
into more serious forms. The most experienced alienist cannot 
tell in the beginning of a simple case to what form it ma}- change, 
or what will be the final outcome. 

The causes of melancholia are heredity, grief, trouble, mental 
and physical overstrain, disease of the digestive apparatus, fevers, 
childbirth, worry, etc. These causes act to produce insanity by the 
strain of overwork or the lack of proper nutrition which they put 
upon the brain, and thus start the brain enfeeblement which is 
manifested in the insanity. The one word which best covers all 
these cases is stress. The brain is capable of doing a great deal 
of work, provided it is properly nourished and gets proper oppor- 
tunity for recuperation. Worry is rapidly exhaustive. Hence long 
vigils at the bedside of sickness and the distress which follows the 
loss of near friends, the sleeplessness and worry over financial loss, 
the imperfect nutrition dependent upon dyspepsia, the toxic effects 
of fever, the exhaustion of childbirth and lactation, worry of do- 
mestic trouble, etc., throw undue stress upon the brain, derange 
the proper relation of waste and repair, and thus bring about the 
disordered function which is insanity. 

In melancholia of the milder forms the prospect for recovery is 
favorable ; in the severer forms, less hopeful, although very severe 
cases sometimes make good recoveries. Simple cases, especially 
those following fever, etc., may completely recover in a few weeks; 
others, after two or three years. I have known one case to re- 
cover after seven years, and instances are on record of recovery 
after still longer periods. The average duration of curable cases 
is about nine or ten months. 

A case of melancholia should be treated by isolation, nursing 
and watching. Occasionally an incipient case can be diverted and 
health re-established by travel and change of scene, but if the case 



806 ' INSANITY. 

has become one of distinct melancholia, travel not only does no 
good, but is positively harmful. If the patient be in a condition to 
have the mind occupied and the attention taken up by travel and 
new scenes, good will be derived therefrom; otherwise, harm will 
result. 

Asa rule it is far better that the nurses and attendants in care 
of a case of melancholia be strangers, with experience in the care 
of the insane. If the resources of the family warrant it, and isola- 
tion, nursing, watching, and competent medical attendance can 
be had at home, home care can be undertaken and successful re- 
sult expected; but this method is practicable only in wealthy 
families in large cities. In most cases the asylum offers the best 
solution. Many families, who are prosperous when all are well, 
are entirely unequal in many respects to the demands of home 
treatment of the insane; hence the home treatment of melan- 
cholia will be limited, practically, to the incipient stages. Even here 
the case should have very careful watching, and the family physi- 
cian should be very attentive. The mild cases are even more 
dangerous as to possible suicide, homicide, or arson, than the 
severer ones, for the latter plainly show their condition, while the 
former, retaining their reasoning power to a large extent, are 
able to plan desperate schemes with as much cunning and deliber- 
ation as a person in sound mental health. Besides, such patients 
are liable to suddenly develop morbid impulses, the sight of a 
weapon may suggest suicide or homicide — the sight of the chil- 
dren suggest that it would be a blessing to them to be removed 
from a world which seems to be shrouded in gloom and woe. 

The greatest care should be taken to prevent suicide by re- 
moving from the patient's domain everything liable to be used 
for this purpose, and watching most carefully against sudden pre- 
cipitation out the window or downstairs. A melancholy patient 
has been known to disembowel herself with scissors, while her 
nurse was sewing by her side. 

In nursing, three points are very important — to keep up 
nutrition, to keep the bowels open, and. to keep the function of 
the skin active. Acute melancholiacs generally take but little 
food willingly and often refuse it altogether, partly because the 
mind is preoccupied, partly because the organic sensations are 
dulled, but more especially because of delusions, that poison is 
mixed with the food, or that the meat is human flesh, or that they 



INSANITY. 80 r 



are too wicked to eat, or if they do eat there will not be enough 
for others. It requires a 'great deal of tact and experience to get 
such a patient to take sufficient food. Sometimes it is impossible, 
and recourse must be had to forced feeding by the stomach or 
nasal tube. Milk, milk and eggs, clear soup slightly thickened 
with arrowroot, strained pea soup, etc., should be given with the 
tube three or four times a day, to which stimulants, digestives, lax- 
atives, etc., can be added as required. Patients have been nourished 
in this way for months, or even years, and ultimately restored to 
health. 

To combat the constipation, laxatives, especially those which 
increase glandular secretions and stimulate the muscular move- 
ments of the intestine, enemas and massage of the bowels, are to 
be used. The frequent use of the ordinary warm bath, followed 
by general massage with inunctions of oil, will keep the skin in 
reasonably good order and aid the nutrition. Incidentally, it 
may be said that the hair in melancholia is generally dry, harsh and 
rough, and that improvement in its condition is an indication of 
mental gain. 

It will be clearly seen from the foregoing that, in the great 
majority of cases, home treatment will not be practicable, and that 
recourse must be had to some institution, especially adapted to 
the care of the insane. Having determined it to be best to send 
the patient to an institution, select one, if you can have a choice, 
under the care of an experienced and competent alienist, place the 
patient therein, then follow the advice of the superintendent as to 
visiting, writing, etc. As a rule melancholy patients, especially 
in the early part of treatment, are made worse by visiting and let- 
ters, and both should be prohibited. Later, a time may come when 
both visits and letters will be beneficial After recovery from an 
attack of melancholia care should be taken to keep the general 
bodily health good, and to avoid brain stress of every kind, lest 
another attack be provoked. 

MANIA. 

In mania we have the exact opposite of melancholia. It is 
characterized by an exalted emotional state, together with exalta- 
tion of other mental and nervous functions and motor excitement. 
The patient appears to be unnaturally quick-witted and talkative ; 
ideas come so rapidly he may not be able to find words to express 



808 , INSANITY. 

them and therefore seems confused ; he talks vehemently, with ex- 
aggerated facial expression and gestures, and he is restless and 
continually on the move. The patient's appetite and digestion 
are good and his spirits high. He is happy and contented, forgets 
care and trouble, and becomes oblivious to usages of society and 
restrictions of law. Both men and women throw to the winds 
their natural reserve and modesty, and deport themselves with un- 
accustomed freedom and inattention to propriety. In the early 
stages of mania the patient appears as though slightly intoxicated. 
Some cases may never go beyond this stage ; others may go on to 
a condition of furious, dangerous excitement in which the patient 
yells, dances, tears his clothing, smashes windows and furniture, 
brooks no interference, and sometimes attacks others with great 
fury and violence. 

Mania is sometimes preceded by an attack of melancholia 
from which the patient appears to recover and regain his natural 
spirits, but he passes the normal state and goes into a condition of 
excitement. In other cases there is a preliminary period, of from 
a few days to a few weeks, of restlessness, eccentric conduct, dis- 
turbed sleep or sleeplessness, loss of appetite, and dull headache, 
in which the patient is unable to properly concentrate his thoughts, 
and feels an incapacity to attend to his usual business. In typical 
cases this condition lasts from one to three months, although at 
the last there may be a sudden, violent explosion. 

Mania shows itself in two forms — simple mania and hallucina- 
tory or delusional mania. 

In simple mania there is excitement, quickened mental opera- 
tion, unnatural good humor, excessive talkativeness, restlessness, 
etc. Delusions, illusions and hallucinations are absent, or if 
present at all, are slight and vague. In hallucinatory or delusional 
mania the hallucinations and delusions are prominent, dominate 
the patient and control his actions. 

Mania may be acute, subacute or chronic. In acute mania 
there is generally great excitement, constant talking and motion, 
with tendency to violence, easily provoked to outrageous acts. 
Subacute mania is less active and violent. Both the acute and sub- 
acute forms may lapse into the chronic, persistent form. 

The duration of mania varies. Very intense cases may last 
but a few days, ending in recovery or death. Milder ones may last 
from a few months to two years, and end in recovery. Of typical 



INSANITY. 809 

cases of simple mania sixty to eighty per cent may be expected 
to recover ; hallucinatory cases are not as likely to recover. About 
four or five per cent prove quickly fatal from the general bodily 
disorder, accompanying the mania, pneumonia, or other complicat- 
ing disorders, or from depression of all the vital forces called 
maniacal exhaustion. Cases which neither recover nor die, lapse 
into chronic mania or into dementia. 

The causes of mania are much the same as those of melan- 
cholia — heredity, mental and physical overexertion, febrile dis- 
eases, childbirth and intemperance being among the most com- 
mon. In the treatment of mania very mild cases can be cared for 
at home, provided the resources of the family are equal to the 
expense. There is even less danger of sudden exhibitions of vio- 
lence than in melancholia, but the restless activity of these cases 
is likely to create a great deal of disturbance. For the more 
severe cases home treatment is inapplicable. Taking it all in all, 
most cases will require asylum control. Occasionally a puerperal 
woman is suddenly seized with violent maniacal symptoms which 
will disappear in two or three days by proper home treatment; 
but if the symptoms do not quickly abate, isolation in an asylum 
will be best. 

The medical treatment should be directed to regulating any 
disordered bodily function, to the calming of nervous excitability, 
relieving sleeplessness and keeping up bodily nutrition. As a rule, 
mild cases of mania take food well and maintain good digestion, 
but in the more violent cases food is neglected from inattention, or 
refused from delusions or absolute loss of appetite, and forced feed- 
ing may be required. As there is great activity of mental and 
physical processes, a large amount of easily digested food will be 
required and alcoholic stimulants will often be necessary. The 
nervous excitement must be quieted by suitable nerve sedatives 
and the sleeplessness overcome by hypnotics. In cases of very high 
maniacal excitement the vital powers are greatly prostrated and 
the patient must be kept in bed by relays of nurses or, what is less 
irritating to him, by some form of mechanical restraint. In these 
cases great attention must be given to keeping up nutrition and 
strength to avoid death from exhaustion. On the other hand, if 
the excitement is not great and the strength is good, exercise to 
the point of fatigue will often be beneficial by keeping the diges- 
tion good, and securing sleep. 



810 . INSANITY. 

PARANOIA. 

A form of insanity, which has been variously named, is now 
generally called paranoia. It is classed by some writers with 
idiocy and imbecility because of the defective nervous develop- 
ment, which is one of its peculiarities; others include it with the 
forms of insanity, which depend upon brain disease. It really ap- 
pears to partake of both forms. Paranoia is a form of mental dis- 
ease, dependent upon a defective nervous organization, either 
congenital or acquired in early life, and characterized by delusions 
and self-exaltation, which do not cause emotional or ideational ex- 
citement or impairment of memory, but which dominate the men- 
tal operations. 

The victims of this form of insanity are peculiar, even in child- 
hood. They may be good scholars, but are eccentric, conceited, 
introspective and not well balanced. Following some trifling sick- 
ness, disappointment, disagreement with a playmate, some business 
complication, etc., or without any known cause, the patient be- 
comes vaguely suspicious and depressed, with feelings that others 
are trying to deprive him of his property or rights. The natural 
consequences of inattention to business are thought to result from 
conspiracy against him. "A patient in this condition enlisted in 
the army. He felt himself watched and checked in his laudable 
undertaking on every hand, and believed that the generals of the 
army — Sherman and Grant — were conspiring to keep him in the 
position of private, and to prevent that reward by promotion to 
/which his abilities and meritorious conduct entitled him." This 
stage of the disease is sometimes called the "persecutory stage." 
Later comes the "transition stage," when some event, emotion, 
hallucination, dream, paragraph, conversation, or the like, may fix 
itself upon the patient's attention and seem to explain the whole 
movement of his life. Delusions multiply; he imagines his course 
of life has been specially planned out for him, by occult processes, 
for some great end ; imagines himself to be of noble birth. ; or even 
a prophet, or Christ ; that he has a wonderful mission to perform. 
He studies the Bible for hidden meanings applicable to himself; 
believes the cause of his having been "persecuted," or "tried," to 
be envy and maliciousness. He begins to formulate the great mis- 
sion he is to accomplish. Some notion of his own, or some public 
incident, claims his attention and dominates and controls his 
actions. 



INSANITY. 811 

These people are often looked upon as cranky, or harmlessly 
insane, but their quiet conduct, business ability, rational conversa- 
tion on general topics, good memory, etc., hide their slumbering 
fire of delusion and obscure the dangerous tendencies — for these 
patients are exceedingly dangerous and only require the stimula- 
tion of some public event, personal collision or crystallizing delu- 
sion, like a spark to gunpowder, to precipitate some appalling ex- 
plosion. A good example of this form of insanity and its violent 
culmination, is that of Prendergast, the assassin of Mayor Har- 
rison of Chicago, who was stimulated to the deed by the idea that 
he had been appointed to champion the cause of the populace, to 
release them from the oppression of the mayor, etc. In short, he 
claimed that he killed the mayor for the benefit of the people at 
large, and not from any personal or selfish motive. Many other 
assassins, and would-be assassins, of distinguished persons have 
been paranoiacs. 

These patients sometimes follow and annoy ladies whom they 
believe to be deeply in love with them, even though they have 
never exchanged a word with them. They may take the notion 
that the wealth in the possession of some noted millionaire is really 
their own, and take measures to secure it by threat or force. Such 
patients are f f ound in every rank of life, and often impose a long 
time on intelligent persons, especially on ladies, ministers and 
lawyers, until they are rudely awakened to the person's real condi- 
tion by some sudden desperate act. The only safe disposition of 
this class of insane is seclusion, which is sometimes impossible to 
secure till homicide has been accomplished. It follows as a mat- 
ter of coure that this form of insanity is not very curable, although 
a cure, or at least a remission for long years occasionally takes 

place. 

DEMENTIA. 

Dementia signifies loss of mind. It is very commonly used by 
the public, and in legal proceedings, to signify any form of insanity, 
but by alienists, its use is restricted to certain forms of mental de- 
rangement, which frequently follow more active types and which 
show, as the most prominent symptoms, an impairment of mental 
power. The term is often confounded with idiocy, and while cer- 
tain forms of dementia do not differ materially from idiocy, the 
two conditions are reached by different routes. The idiot has 
never developed mentality ; he has always been weakminded — the 



812 < INSANITY. 

dement has been the possessor of normal mental power, which has 
become impaired by brain disease. 

Dementia will be considered under three forms — primary 
dementia, terminal dementia, and senile dementia. 

Primary Dementia, also called stuporous insanity, is a form of 
mental derangement evinced by a more or less marked weakening 
of the mental powers, not secondary to any other form of insanity, 
but coming on as an original mental disorder in a person previously 
of sound mind. This form of insanity may come suddenly from 
some overwhelming mental shock and reach its height in a very 
short time, or it may come on gradually, perhaps with periods of 
remission or intermission. In the slowly developing cases the 
patient loses interest in what has usually interested him ; he grows 
careless in dress and habits, displays excessive grief or joy at slight 
occurrences, finds difficulty in fixing his attention, becomes for- 
getful, unable to attend to his usual occupation, and incoherent 
both in speech and writing, loses his sense of modesty and decency, 
neglects the calls of nature, etc. 

This form of insanity is seen only in young persons, who, as a 
rule, have not passed their twenty-fifth year, and have inherited 
tendencies to insanity. It is very likely to depend for its immediate 
cause upon masturbation, inanition, exhausting discharges, etc., 
or gradual or sudden exhaustion of the nervous system. It ends 
in recovery in a majority of cases in from two or three to five or six 
months ; the younger the patient and the more sudden the onset, 
the more rapid the recovery. Cases caused by masturbation are 
the least favorable. Cases which do not recover, lapse into the 
dull, apathetic form of terminal dementia, frequently complicated 
with pulmonary disease. 

The treatment of these cases consists of good nursing and 
great care-taking, liberal feeding, with reconstructive tonics and 
stimulants to invigorate the weakened brain. 

Terminal Dementia — Cases of acute insanity may terminate 
by recovery, by death from exhaustion, or by becoming chronic 
and incurable. The first two classes are obviously removed from 
the ranks of the insane; the chronic and incurable residuum is 
what constitutes the mass of insanity, which exists at any one time, 
and which fills our asylums and receptacles. Cases of chronic in- 
sanity sometimes retain to a greater or less degree the symptoms 
which marked their acute stage and become, therefore, chronic 



INSANITY. 813 

melancholia, chronic mania, etc., but the majority of uncured cases 
tend to an impairment or weakening of the mental powers — that is, 
to a decay of the mental faculties. This mental enfeeblement, con- 
sequent upon a preexisting acute insanity, is called terminal de- 
mentia. 

Terminal dementia may vary in degree from but slight mental 
impairment to complete fatuity. Employment of both body and 
mind helps to postpone mental decay, and in public institutions 
for the insane chronic cases are encouraged to work, mainly for 
the benefit which occupation brings to the patients and only in- 
cidentally for the value of their labor. Many of these cases, under 
the guidance, control and support of the asylum, prove excellent 
helpers, but they rarely do as well at home, and are incompetent 
to meet the exigencies of ordinary life. Those who are extremely 
demented require to be taken care of like children, and are often 
very untidy and destructive. 

There is no medical treatment for terminal dementia. The 
brain has suffered irreparable damage, and the most that can be 
done is to preserve, by judicious management, as long as possible, 
what mental power is left. The illusions, hallucinations and de- 
lusions, as well as the morbid impulses, fears and tendencies, which 
existed in the acute stage of the insanity, may continue to exist in 
the terminal dementia until the mind becomes too weak to retain 
them. 

Senile Dementia. — The natural history of the bodily organism 
is a period of growth, a period of maturity and period of decay. 
This is especially marked in the brain, the most complex organ in 
the body. Keeping step with these material changes there is in 
infancy, youth and adolescence, a period of mental growth and de- 
velopment, in middle life a period of mental maturity, and in old 
age a period of mental decay. This mental decay of old age is 
called senile dementia. The first symptom noticed is almost al- 
ways a weakness of the memory which is followed by other evi- 
dences of failing intelligence. The patient fails to recognize his 
old acquaintances, or even his own children. He forgets where 
he lives, cannot find his way from room to room in his own house, 
and repeats the same question or story over and over, forgetting 
that he has previously A T oiced the same words. 

The age at which senile dementia spontaneously makes its ap- 
pearance varies considerably ; it is rarely seen before the sixtieth 



814 - INSANITY. 

year, generally not till the sixty-fifth or seventieth, and sometimes 
not until much later. There is also great difference in the degree 
of senility and the rapidity with which it develops; some persons 
at eighty-five being as vigorous as others at sixty. Wounds, in- 
juries, westing diseases or excessive use (comparatively) of the 
mind, may bring on senile changes as early as the fiftieth year. 

This ordinary senile mental decay can scarcely be regarded as 
pathological or as insanity ; but it not unfrequently happens that 
radical changes in character and disposition are the first indica- 
tions of senility. Such changes continue to be the most prominent 
symptoms and may take on a serious, dangerous or homicidal char- 
acter. The liberal husband and father becomes penurious and 
miserly, refusing to provide his family and himself sufficient food 
to prevent starvation; or he may become prodigal and squander 
his means on disreputable characters with whom he had never 
been accustomed to associate. He may attempt to destroy prop- 
erty by fire or otherwise, or may endanger the lives of his family. 

When these unnatural and unusual mental symptoms occur, 
it is clear that the brain changes have been of a pathological or 
diseased character, and that the condition is one of insanity in- 
stead of natural decay. These cases of real insanity should be 
protected from doing harm to their property, to themselves and 
to their families, by being adjudged insane, by having a guardian 
appointed to look after their business interests, and by sequestra- 
tion. Very old people do not, as a rule, well bear being sent to 
an asylum. It seems to act upon them like the transplanting of 
an old tree. The removal from long-time associations and sur- 
roundings is a shock from which they may never rally, and they 
may survive but a short time. 

In a case of this kind in a wealthy family, to which I was 
called in consultation, 1 had a whole house set apart for the in- 
valid, his nurses, housekeeper, etc., from which the other mem- 
bers of the family were excluded. The result was satisfactory; the 
old gentleman became quiet and manageable, and ere long passed 
away at his own home. But it goes without saying that such a 
method must be expensive, and that with people of limited re- 
sources the restraint of the asylum offers the only practicable solu- 
tion of such a problem. It also follows that senile decay, both of 
the bodv and mind, can terminate only in death, and that treat- 
ment must needs be limited to smoothing as much as possible the 
rugged pathway. 



INSANITY. 815 

PARETIC DEMENTIA. 
(Genera! Parab'sis. Paresis.) 

Paretic dementia is a form of insanity characterized by pro- 
gressive mental enfeeblement, muscular inco-ordination, delusions 
of wealth and grandeur, ultimate decay of mental and bodily pow- 
ers, and death. It is a disease of the most vigorous period of adult 
life, occurring most frequently between thirty-five and fifty years of 
age. It attacks men much more frequently than it does women, 
the proportion averaging about six men to one woman. Its vic- 
tims are as a rule among the most active and vigorous ; it rarely 
attacks the sickly and feeble, and rarely follows other forms of in- 
sanity. It is most likely to occur in persons who have imposed too 
great burdens upon the nervous system, by overwork, intemper- 
ance, sexual excess, etc., resulting in exhaustion of nerve force, 
or from syphilis, which sets on foot subtle organic degenerative 
changes in the brain cells. The brain disease which underlies this 
form of insanity is easily demonstrated as an inflammatory degen- 
eration of the cortex (gray outer portion of the brain), which is 
the portion essentially engaged in mental operations. A patient 
attacked by paretic dementia, at first shows slight mental defects, 
such as forgetfulness, carelessness in dress and behavior, irritability, 
loss of delicate shades of refinement, etc. He soon becomes erratic 
and visionary, full of expansive ideas of business and impractica- 
ble schemes. He becomes extravagant and wasteful of his means 
and squanders property in foolish ventures. He begins to have a 
thickness of speech, slurring or dropping letters or words like a 
partially intoxicated person. Indeed, these early symptoms of 
paresis are often mistaken by the patient's friends for evidences of 
excess in drinking. Then comes a tendency to appropriate any- 
thing within his reach, under the idea that it belongs to him. The 
patient, also, becomes very irritable and violently resents inter- 
ference ; and there may even be maniacal attacks of great violence. 
Delusions of wealth and grandeur multiply apace, until he be- 
lieves he is the strongest man in the world, that he controls every 
business, that he is possessed of untold millions, that he owns gold 
and silver mines yielding him train loads of these metals daily, 
etc. These expansive delusions are likely to take a tinge from 
the patient's previous occupation, thus a stonemason thought he 
was to build a stone bridge across the Atlantic; a locomotive en- 
gineer claimed to have an engine, the cab of which was hollowed 



816 - INSANITY. 

from an enormous diamond, which laid its own track and would 
run to England in twenty-four hours ; and another claimed to have 
an engine with cylinders five hundred inches in diameter, driving 
wheels live hundred feet across, and a flag-pole on the cab five 
hundred miles high. 

The muscular inco-ordination and paralysis increase until the 
patient is unable to articulate, to walk, or to help himself at all. 
Apoplectiform or epileptiform seizures occur. Death may come 
suddenly in one of these seizures, or gradually, from slow exhaus- 
tion and general failure of nutrition, often with the development 
of bedsores upon prominent points, or even the sloughing of an 
ankle where the other has lain across it. At last the patient is as 
helpless as an infant, and when unable to help himself and scarcely 
able to speak, will still answer, in reply to the question: How are 
you? "A — all r — ri — right." Occasionally a case is seen in which 
the delusions are of a depressing nature. 

There is no cure for paretic dementia. Remissions sometimes 
occur in which the patient, under control, may seem to be almost 
restored, but, on attempting to resume an active occupation, 
breaks down at once. The average duration of this disease is about 
three years, but occasionally a case runs, its course in a few months, 
or on the other hand, may last ten or twelve years. It is well nigh 
impossible to care for this form of insanity in an ordinary home, 
and the institution affords the best recourse. 

GENERAL CONSIDERATIONS. PREVENTION. 

The classification of insanity as here given is considered suffi- 
cient for our purposes. Much more elaborate classifications are 
used by specialists. Certain views touching insanity, and* some 
peculiarities which attend many cases, deserve a brief notice. 

Lunacy is an old name for mental derangement, founded upon 
the idea that it is caused by some malign influence of the moon 
(luna). The only influence, however, that the moon has on in- 
sanity, is the same that it has upon some sane persons who sleep 
lightly — namely, some sane as well as some insane people are more 
wakeful in bright moonlight nights, simply because of the light. 

Certain cases of insanity have a more or less marked periodic- 
ity. Melancholiacs are more depressed in the early morning, sim- 
ply because the vital forces are less active at that time, and the 
worry of a sleepless night then culminates. Suicide is especially 



INSANITY. 817 

to be guarded against in the early morning hours. In women men- 
struation is generally suspended during acute insanity. The arrest 
of menstruation is not the cause of insanity, but a consequence of 
it, or rather a consequence of the profound depression of the vital 
forces which accompanies the insanity. Hence the restoration of 
this function is a good sign because it shows recuperation of vital 
force. In some cases of acute insanity and in many of chronic de- 
rangement, menstruation continues and the manifestations of in- 
sanity are intensified at the menstrual period. 

Certain persons are subject to frequently recurring attacks of 
insanity — recurrent melancholia or mania, the latter being more 
common. Generally the attacks grow more frequent and of longer 
duration, and finally produce more or less marked dementia. At 
first these attacks may be several years apart and the patient be en- 
tirely well in the intervals, but ultimately they have to remain con- 
tinuously at the asylum. 

There is a form of insanity, manifested by the alternations of 
excitement and depression, called circular insanity. The circle of 
changes may occupy a few weeks or many months, and there may 
be a period of considerable duration, in which the patient appears 
almost natural; but whenever this vicious cycle is once set up re- 
covery is well nigh hopeless. 

Epilepsy may continue many years without impairing the 
mental faculties, but usually the mind soon becomes affected, and 
epileptic insanity supervenes. Epileptic insanity and the automatic 
mental state which may precede or follow epileptic attacks, con- 
stitute a violent and very dangerous form of mental disease, and 
one very likely to lead to homicide. 

The stress of the puerperal state not unfrequently causes in- 
sanity, especially in those predisposed thereto. This insanity may 
assume the form of melancholia or mania. It is especially im- 
portant in puerperal insanity to be very watchful, lest the woman 
injure herself or her child. 

The use of alcoholic drink may cause several different forms 
of insanity: First — The condition of acute inebriety, drunkenness, 
not usually classed as insanity because of its brief duration. Sec- 
ond — Delirium tremens, a violent acute apprehensive delirium. 
Third — Ordinary acute mania. Fourth — The so-called alcoholic 
insanity characterized by change of character, suspicions, marital 
jealousy, etc. Fifth — Chronic degeneration, of the type of senile 

52 



818 . INSANITY. 

dementia or general paralysis. Similar conditions follow the use 
of other drugs, such as morphine, chloral and cocaine. 

Years ago the belief was general that the insane were sub- 
jects of demoniacal possession, hence grew up a fear of the insane 
and a tendency to cast them out of the realms of friendship and of 
hope. It is now known that insanity is but the manifestation of 
bodily disease, yet the old feelings regarding it have not all passed 
away. By many, at the present day, insanity is looked upon as a 
disgrace and the going to an institution for the insane regarded as 
a stigma. But insanity is no more a disgrace than any other sick- 
ness. When other illness comes upon one as the result of evil- 
doing, of bad habits, of dissoluteness or dissipation, it is a disgrace 
inasmuch as it is a badge of disreputableness ; but sickness that 
comes unavoidably is a misfortune, not a disgrace. Exactly the 
same distinction holds good with insanity. It is disgraceful when 
the causes which brought it on are discreditable, otherwise it is 
simply a misfortune, but as insanity affects the highest distinctive 
human attribute, mentality, which is the gauge of the individual's 
personality, the ego, it is a much greater misfortune than ordinary 
bodily disease. Furthermore, insanity is much the most trouble- 
some of all maladies to care for, because of the peculiar difficulties 
and dangers which attend it. The delusions of the insane which 
are liable to attach to their best friends, the refusal of food, the vio- 
lence, the danger of arson, and of suicide and homicide, render the 
care of the insane particularly difficult, especially at home. 

In very young persons whose after-life might be clouded by 
having been sent away as insane, in very old persons who have but 
a short time to live, in puerperal cases where convalescence may 
occur in a few days, and in cases where mental failure in general 
bodily disease evidently precedes dissolution but a short time, the 
patient should be cared for at home if possible; but even here, the 
question of financial resources, strength, house-room, etc., may be 
controlling, and necessitate sending the patient away. 

Originally, institutions for the insane were only receptacles 
for secure custody, and chains and dungeons were of common use. 
But science and humanity have wrought great changes, and asy- 
lums are now (generally) organized and conducted for the most en- 
lightened and curative treatment of this unfortunate class. Years 
ago, when hospital was a rather forbidding word with unpleasant 
associations, it was avoided in connection with the insane and the, 



INSANITY. 819 

then, softer word asylum was preferred. Now, that the public 
is better educated as to hospital work, the tendency is reversed 
and in many states asylum has been changed to hospital. Of late 
years there has been increasing attention given to the medical 
treatment of mental disease, nevertheless the chronic hopeless cases 
will always outnumber the acute and presumably curable ones, 
ten to one. The new cases, as they arise, necessarily speedily di- 
vide into three classes : those which soon die from the violence of 
their disease, those which recover, and those which become chronic 
and incurable. It is this residuum of unrecovered cases which con- 
stitutes the great mass of existing insanity. 

There have been very widely divergent views as to the curabil- 
ity of insanity. At one time the popular belief was that it was 
very seldom, if ever, cured. In the early part of the nineteenth 
century, the great improvement wrought by the modern humane 
treatment of chronic cases, together with the enthusiasm of asy- 
lum superintendents, led to the claim that nearly ail could be cured, 
provided they were properly treated in the early stages. More 
thorough and candid study shows that of the cases as they arise, 
just about one-half recover. The public still holds erroneous ideas 
as to the curable cases. Many, many times have patients been 
brought to me with the statement : "There is not much the mat- 
ter with this man, he has been acting a little queer for two or three 
years, but has been able to attend to his business until the last few 
weeks; he will soon be all right again." The fact is, such cases are 
very unfavorable. On the other hand, cases of acute rapidly de- 
veloping mania or melancholia give a large percentage of recov- 
eries. 

The asylum, or hospital in some form, has a twofold func- 
tion : the cure of the curable and the custody of the incurable. As 
a rule, it affords the best prospect of cure for several reasons : The 
medical officers have had long experience in treating mental dis- 
eases ; the nurses, attendants and other employes are trained in 
the work ; the dangers are very largely eliminated, and the insane 
generally accept care and control at the hands of strangers with 
much less objection and irritation than from relatives and friends.* 



* When institutions for the insane, and other defectives are made political per- 
quisites and with every change of administration a new set of campaign strikers, in- 
experienced and untrained in the work are put in charge, great wrong is done the 
insane, their friends and the state. The public should protect itself against such mal- 
administration. 



820 INSANITY. 

As far as chronic and incurable cases are concerned, the func- 
tion of the asylum is simply custodial. Generally, cases of chronic 
insanity are very troublesome, if not dangerous, at home, and exert 
a decidedly unfavorable influence, especially upon the young. As 
a rule, therefore, the chronic cases would better be in the asylum, 
but some cases under favorable conditions do well at home. 

The insane are the wards of the state, and the state therefore 
establishes and supports institutions for their care. These asylums 
generally provide good treatment and good care for their inmates, 
are generally managed by experienced superintendents for the 
benefit of the patients, and are worthy of confidence. There should 
be no exceptions to this rule. While public institutions should, 
and generally do, give good care, they are necessarily managed 
economically and nothing is expended for luxuries. For those 
who have abundant means and desire to furnish insane friends 
with accustomed luxuries, there are private institutions worthy 
of confidence. 

The insane are sick persons, and whether or not to send a 
lunatic to an institution, is essentially a medical question which 
should be decided by the physician, just as he decides the ordering 
to bed of a fever case, or the kind of splint to put upon a fractured 
limb. Unfortunately, in many states this purely medical question 
has been delegated to the courts and its solution savors of criminal 
jurisprudence. The victim of brain disease has to be tried for and 
convicted of insanity, and goes to the asylum with the idea that he 
has, been sentenced as a criminal. Inasmuch as property interests 
are often affected by insanity, it is desirable that there be some 
judicial cognizance of this condition when it exists. The best way 
to meet the medical and judicial requirements in a case of sup- 
posed insanity, would be to have the court appoint a medical com- 
mission which should examine the case and report, then have the 
court act upon their report. 

Insanity is especially a disease of modern times and of high 
civilization. Uncivilized people put but slight tax upon their men- 
tal machinery, hence develop very little insanity; but among the 
leading nations of the world, emotional strain, business cares, 
financial worry, dissipation, etc., are liable to lay that stress upon 
the brain which is the immediate cause of insanity. The propor- 
tion of insane persons varies : the maximum, about three in one 



INSANITY. 821 

thousand of population, being found in the older and more densely 
settled states or countries. 

An ounce of prevention is better than a pound of cure, runs 
an old adage, and to nothing does it apply better than to insanity. 
A large proportion of mental derangement is hereditary. This 
does not mean that in all cases of hereditary insanity, the subject 
is born insane. The congenital idiot or imbecile is born defective, 
but children are not born insane, in the common acceptation of 
the word. But just as there runs in certain families a tendency 
for the children as they grow to adult life, to develop certain family 
peculiarities as to hair, color of eyes, shape of features, tone of 
voice, and movement, so there runs in families a tendency to the 
development of different diseases, as rheumatism, gout, consump- 
tion and insanity. Persons who inherit a tendency to insanity 
are much more liable to become insane than those who do not ; and 
insanity in such persons is very likely to be developed under the 
strain incident to the critical periods of life, as puberty, adolescence, 
climacteric, or the special stress of child-bearing, or of emotional 
strain. 

It goes without saying that if all persons who inherit tend- 
encies to insanity were to refrain from entering the marital rela- 
tion the result would greatly lessen the amount of insanity in com- 
ing generations. In a few instances we have known persons to 
deliberately determine against marriage on this account, but peo- 
ple generally are not controlled by such lofty ideas. 

The foundation for mental derangement is frequently laid in 
infancy and early childhood through failure of parents to teach 
their children proper self-control. Allowed to grow up without 
learning the important lesson of self-denial and self-mastery, they 
are liable, by vicious physical and mental indulgences, to sow the 
wind, that in the harvest time of later life, becomes the whirlwind. 
Overwork, the unrelenting tasks of poverty, unrestrained ambition, 
irregular life, dissipation, struggle for supremacy, the exactions of 
complicated and harassing business, inattention to the laws of 
health, excessive grief, etc., are likely to prove excitants which 
may produce insanity with or without predisposing causes. With 
a sound body will be associated mental integrity. When all ob- 
serve the laws of physical, mental and moral hygiene, insanity will 
be rare. 



GLOSSARY. 



For -words defined in connection -with their use i?i this zcork, consult the index. 



Abdomen, The part of f he body con- 
taining the stomach and intestines. 

Abdominal, Pertaining to the abdomen. 

Aberration, A state of partial insanity. 

Abnormal, Irregular; unnatural. 

Abrasion, The act of rubbing away by 
friction. 

Absorbent, That which takes up or ab- 
sorbs liquids. 

Absorption, Taking up substances from 
within or without the body. 

Acne, Pimples on the face, most com- 
mon at puberty. 

Acromegaly, A disease characterized 
by excessive increase in the size of 
the bones. 

Acromygalia, A rare nervous disease, 
usually causing paralysis and death. 

Acute, Active, with rapid progress and 
violent symptoms, the opposite of 
chronic. 

Adolescence, The time between puberty 

and full development. 
Adventitious, Added or acquired. 
Aeration, The process of mixing with 

air. 

Aerobic, Pertaining to bacteria able to 
live in contact with air and to absorb 
oxygen. 

Afferent, Conducting or bearing in ; as 
an afferent artery. 

Albumin, A thick, sticky substance 
forming a part of animal fluids and 
solids, and resembling the white of an 
egg- 

Albuminoid, Resembling albumin. 

Albuminuria, A disease of the kidneys, 

characterized by albumin in the urine. 
Algea, A sea-weed. 
Alienist, One skilled in the treatment 

of mental diseases. 
Alimentary, Pertaining to that which 

nourishes. 
Alkaloid. A compound of alkali and 

some other substance. 



Alterative, A remedy which by de- 
grees changes the constitution, and re- 
stores to health. 

Ameba, One of the lowest forms of life. 

Amputation, Cutting off a limb. 

Anaemia, A lack of blood, or of red 
cells in the blood. 

Anarsarca, A diffusion of serous fluids 
into the connective tissues ; a general 
dropsy. 

Anastomosis, The opening of the ves- 
sels of one system into those of an- 
other, as the union of the arteries and 
veins. 

Anatomically, As regards structure; 
pertaining to anatomy. 

Anatomy, The structure of the body 
with reference to its parts. 

Anerobic, Pertaining to bacteria that 
live without air. 

Anaesthetic. A medicine or agency that 
prevents feeling. 

Anglesia, Inability to feel pain. 

Anodyne, A medicine which relieves 
pain. 

Antidote, That which counteracts the 
effect of a poison when taken into the 
stomach. 

Anterior, Before ; in the front position. 

Antifebrile, A remedy which overcomes 
or cures fever. 

Anus, The opening at the lower end of 
the alimentary canal through which 
the excrement leaves the body. 

Aphasia, Loss of the use of words, both 
spoken and written, without loss of 
the vocal organs or impairment of the 
mind, resulting from a brain injury. 

Apoplexy, Pressure upon the brain 
caused by a ruptured blood vessel. 

Aqua, Water. 

Areola, The colored ring around the 
nipple. 

Areolar tissue. The network of fibers 
extending over the body and binding 

23 



824 



GLOSSARY. 



its organs together, and connecting the 
skin with the deeper tissues. 
Aromatic, A fragrant drug, usually hav- 
ing a pungent taste. 
Arrector, That which causes to stand. 
Artery, A vessel which conveys blood 

from the heart. 
Arthritis, Inflammation of the joints. 
Articular, Pertaining to the joints. 
Articulation, A joint. 
Aseptic, Free from the living germs of 
disease, fermentation or putrefaction. 
Assimilation, Transformation into its 
own substance of matters foreign to 
the body. 
Astringents, Medicines which by con- 
tracting the tissues restrain excessive 
evacuations and hemorrhages; the op- 
posite of laxatives. 
Atrophic, Showing or undergoing 

atrophy. 
Atrophy, Wasting away because of im- 
perfect nourishment. 
Auditory, Pertaining to the hearing. 
Automatic, Self-acting; not under con- 
trol of the will. 
Autopsy, Post mortem ; the opening and 
* examination of the body after death. 

Axilla, The arm-pit. 
Axis, An imaginary straight line pass- 
ing through the cenrer of a body and 
on which that body may be supposed 
to revolve. 
Bacillus, Bacilli, A rod-shaped bac- 
terium. 
Bacteria, Microscopic organisms; dis- 
ease germs. 
Benign, Harmless. 
Bilateral, Having two sides. 
Bile, A bitter, yellow, sticky fluid secre- 
ted by the liver. 
Biliary, Pertaining to the bile. 
Bilious, A deranged condition attended 

by disordered bile. 
Bloody-flux, A disease characterized 

by frequent bloody stools. 
Brachial, Belonging to or resembling 

the arm. 
Broad ligaments, The folds of the peri- 
toneum which support the uterus and 
contain the ovaries and fallopian 
tubes. 
Bronchial, Pertaining to the bronchi, 

or air tubes of the lungs. 
Cachexia, A morbid condition of the 
body resulting from disease. 



Calcareous, Containing lime. 

Calculus, calculi, A concretion formed 
by the deposit of solid matter, as soda, 
lime, uric acid, etc., usually in the 
reservoirs of the body. 

Capillary, A very minute passage or 
canal. 

Carbolize, To impregnate with carbolic 
acid. 

Carburetted, Combined with carbon. 

Carcinoma, A cancer. 

Cardiac, Pertaining to the heart. 

Carotids, The large arteries in the sides 
of the neck. 

Cartilage, A solid substance occurring 
in the joints, at the ends of the ribs, 
breast bone, etc. 

Casein, Cheese curd; the part of milk 
containing nitrogen. 

Catamenia, The discharge of f the 
menses. 

Catarrh, An inflammation of a mucous 
membrane, especially those of the air 
passages of the head and throat, ac- 
companied by an exudation. 

Catheter, An instrument for introduc- 
tion into the urethra to empty the 
bladder. 

Caustic, A medicine which destroys 
animal tissues. 

Cauterize, To burn or sear by means 
of heat or caustics. 

Cautery, A burning or searing of the 
flesh. 

Cell, A minute vessel or sac having 
membranous walls or sides, and con- 
taining fluid. Cells constitute the cel- 
lular tissues of animals and plants, and 
by their growth and reproduction make 
up the growth of these parts. 

Cellulitis, Inflammation of cellular tis- 
sue. 

Cerebellum, The small or posterior 
brain. 

Cerebral, Pertaining to the cerebrum. 

Cerebrum, The upper larger portion of 
the brain. 

Cerebration, Action of the brain. 

Cervical, Pertaining to the neck. 

Cholesterine, A fatty substance found 
in the bile. 

Chyle, Food digested and ready for ab- 
sorption. 

Chyme, The food after it has been acted 
upon by the gastric juices. 

Chronic, Moderate, slow, continuing a 
long time. 



GLOSSARY. 



825 



Cicatrix, A scar formed in the process 
of healing. 

Cicatrization, The process of healing. 

Cilia, Small hairs. 

Circumcision, Cutting off the prepuce 
of males, or the lesser labia of females. 

Clavicle, The collar bone. 

Clinical, Belonging to the bed; bed- 
side. 

Clyster, An injection. 

Coagulants, Substances which cause 
coagulation or curdling. 

Coagulate, To harden and thicken like 
the white of an egg under the action 
of heat. 

Coccus, pl., cocci, A kind of bacteria. 

Coccygeal, Pertaining to the coccyx. 

Coccyx, The four lowest vertebrae of 
the backbone. 

Comatose, Pertaining to coma ; sleepy. 

Conception, The first formation of the 
embryo. 

Condiments. Substances used to give 
relish to food. 

Congenital, That which is born with 
one; a tendency dating from birth. 

Congestion, An excessive supply of 
blood in a part or organ. 

Contagion, Germs that transmit disease 
by contact direct or indirect. 

Contusion, A bruise. 

Convalescence, The period of recovery 
from an illness. 

Convulsion, An involuntary violent con- 
traction of the muscular parts of the 
body. 

Copulation, Sexual intercourse. 

Corollary, Something so closely follow- 
ing as to need no demonstration. 

Corpuscle, An animal cell. 

Cortical, Pertaining to the outer part 
or cortex. 

Costal, Belonging to the ribs. 

Cranial, Of the cranium. 

Cranium, The skull. 

Cretinism, A state or disease of idiocy, 
often found in the Alps. 

Cyanosis, A bluish or dark color of the 
skin due to imperfect circulation. 

Cyst, A bladder-like sac usually contain- 
ing poisonous matter. 

Debris, Broken pieces or rubbish left 
after the destruction of anything. 

Decidual, Likely to be shed at a certain 
stage of growth. 



Defecation, Voiding of excrement 
from the bowels. 

Degeneration, The act of becoming 
worse, or the state of being worse. 

Deglutition, The power of swallowing. 

Dejections, Voided matter ; excrement. 

Delirium, Insanity; frenzy; derange- 
ment. 

Deleterious, Poisonous ; destructive. 

Dentition, The process of cutting 
teeth. 

Depressent, A medicine that allays irri- 
tion and pain; a sedative. 

Derma, The true skin or corium ; also 
used of the skin in general. 

Devitalize, To deprive of vitality or 
life. 

Dextra, The right side. 

Diagnosis, The determination of a dis- 
ease by its characteristic signs. 

Diaphoretic, That which causes perspir- 
ation. 

Diaphragm, The muscle separating the 
chest from the abdomen. 

Dtastase, A substance found in barley, 
oats and wheat after germination. 

Diastatic, Pertaining to the separation 
of the main shaft of a bone from its 
epiphyses, separation of the skull bones 
at the sutures; pertaining to diastase. 

Diathesis, A predisposing condition; a 
tendency. 

Dietary, Pertaining to diet. 

Dilitation, Enlargement of an opening 
or organ. 

Disinfectant, Anything capable of de- 
stroying the life of disease germs. 

Disinfection, The destruction of the 
life of infection. 

Dorsal. Of or pertaining to the back. 

Douche, A dash of water; a current 
directed somewhat forcibly against 
some part of the body for cleansing 
or medicinal purposes. 

Dysmenorrhea, Difficult or painful 
menstruation. 

Dyspnoea, Difficult or labored breath- 
ing. 

Eclampsia, A convulsive disorder at- 
tending pregnancy. 

Eczematous, Like eczema. 

Edema. A puffed or swollen condition 
caused by an accumulation of serous 
fluid in the tissues. 

Efferent, Bearing or conducting out. 

Effete, Worn out; barren. 



826 



GLOSSARY. 



Effusion, The pouring out of fluid into 

a cavity of the body. 
Electrolysis, Chemical decomposition 

by electricity. 
Emaciation, Being lean from the loss 

of flesh. 
Embryo, The first elements of a young 

animal developed in the womb. 
Emollients, Medicines which allay 

outside irritation by softening the 

skin. 
Endemic, Peculiar to the people of a 

certain nation or locality. 
Enema, An injection thrown into the 

rectum as a medicine or for nourish- 
ment. 
Enteric, Belonging to the intestines. 
Environment, The surroundings. 
Epidermis, The outer layer of the skin. 
Epigastrium, The upper central part of 

the abdomen ; the pit of the stomach. 
Epithelioma, An epithelial cancer. 
Epistaxis, Bleeding from the nose. 
Epithelium, The layer of cells lining 

the alimentary canal and the passages 

connecting with it. 
Erosion, The condition of being eaten 

or worn away. 
Eructation, A belching of wind from 

the stomach. 
Erysipelatous, Like erysipelas. 
Erythematous, Pertaining to erythema, 

a disease of the skin. 
Esophagus, The food passage leading 

into the stomach. 
Excrement, Matter discharged as use- 
less from the body of an animal. 
Excrete, To throw out or discharge. 
Excretions, Effete matter thrown off 

from the animal system. 
Excretory, Pertaining to that which ex- 
cretes or is excreted. 
Exfoliation, Scaling or peeling of the 

skin. 
Expiration, The act of breathing out 

or expelling air from the lungs. 
Exsanguinate, To make bloodless. 
Extravasation, Pouring out; effusion. 
Exudation. That which is discharged 

through the pores, as sweat. 
Facetted, Covered with facets or faces. 
Fascia, The thin covering which binds 

the muscles of the limbs to their 

places. 
Fatuity, Imbecility; foolishness. 



Farinaceous, Made of meal or flour. 

Febrile, Feverish, like fever. 

Feces, The excrement of an animal; the 
discharges from the bowels. 

Fermentation, A decomposition pro- 
duced either by the action of living 
organisms or by certain inorganic 
agents. 

Fermentative, Causing fermentation. 

Fertilization, The act of impregnating 
or making the ovum fruitful. 

Fetal, Pertaining to the fetus. 

Fetid, Having an offensive smell. 

Fetor, Offensive smell. 

Fetus, A young animal yet in the womb. 

Fibrin, A nitrogenous substance found 
in the blood and chyle. 

Fibroid, Fibrous; like fiber. 

Filiform, Having the form of a thread. 

Fimbria, A fringe or fringing process. 

Fimbriated, Fringed. 

Flatulence, An accumulation of gas in 
the stomach or bowels. 

Follicle, A little sac, gland or cavity in 
an animal body, particularly in the 
skin. 

Fomentation, A warm poultice, or warm 
wet cloths applied to ease pain. 

Function, The peculiar action or pur- 
pose of a special organ or part. 

Fungus, pl. fungi, A low order of 
plants ; a morbid growth. 

Galvanism, Electricity produced by a 
chemical battery, the same as voltaic 
electricity. 

Galvanization, The process of subject- 
ing to the action of galvanic electric- 
ity. 

Ganglion, pl. ganglia, A collection of 
nerve cells from which nerve fibers 
radiate. 

Gangrene, The first stage of mortifica- 
tion of the softer structures of the 
body. 

Gastralgia, A neuralgia of the stomach; 
bellyache. 

Gastric, Pertaining to the stomach. 

Gastro-intestinal, Pertaining to the 
stomach and the intestines. 

Generation, The act of begetting young. 

Genitals, The organs of generation; 
sexual organs. 

Germicide, Anything capable of killing 
germs. 

Germinal, Pertaining to a germ. 



GLOSSARY. 



827 



Gestation, Pregnancy. 

Gigantism, Of abnormally great size. 

Glans, Apex of the penis. 

Glottis, The opening from the throat 
into the windpipe. 

Glycogen, Animal starch. 

Granular, Composed of granules or 
grains. 

Granulation, The process of forming 
grains or granules. 

Habitue, One accustomed to a particu- 
lar place or employment. 

Haematuria, Blood in the urine. 

Hectic Fever, A fever accompanying 
great exhaustion. 

Hemoglobin, The red substance of the 
red blood corpuscles. 

Hemorrhage, A discharge of blood from 
a blood vessel. 

Hemorrhoids, The piles; painful 
bunches or tubercles about the anus. 

Hepatic, Pertaining to the liver. 

Hereditary, Transmitted from parent to 
child. 

Heredity, The transmission of a tend- 
ency from parent to child. 

Hyaline, Transparent, resembling glass. 

Hygiene, The principles or laws of 
health. 

Hygrometer, An instrument for show- 
ing the proportion of moisture in the 
air. 

Hyperplasia, Overgrowth of a part 

. from increase of cells. 

Hypertrophy, Overgrowth. 

Hyperemia, An over abundance of 
blood in any part of the body, the un- 
natural fullness and redness imme- 
diately preceding inflammation. 

Hypertrophic, Tending to hypertrophy. 

Hypochondriasis, Low spirts; a morbid 
state of the mind. 

Hypodermic, Introduced or found under 
the skin. 

Hypogastrium, The lowest part of the 
abdomen. 

Idiopathic, Independent of any other 
disease. 

Idiosyncrasy, The constitutional pecu- 
liarities of an individual. 

Iliac Regions, The sides of the abdomen 
between the ribs and hips. 

Imbecile, Weak ; feeble in body and 
mind. 



Immune, Exempt from a disease. 

Implicate, To bring into connection 
with. 

Impregnated, Made pregnant. 

Inanition, Exhaustion from lack of 
food or nutrition. 

Incontinence, Inability to retain, as loss 
of control over the urinary bladder. 

Incubus, A sensation of trouble during 
sleep; nightmare. 

Indigenous, Born in or native of. 

Incubation, The time between the ex- 
posure to a contagious disease and the 
beginning of the resulting attack. 

Infection. Living germs which leaving 
one animal and coming in contact with 
another may cause the disease in the 
second with which the first was af- 
fected, without the two animals com- 
ing in contact with each other either 
directly or indirectly. 

Infectious, Pertaining to infection. 

Infiltrate, To enter through the pores. 

Inflammation, A morbid condition usu- 
ally characterized by pain, heat, red- 
ness and swelling. In scientific lan- 
guage, inflammation is designated by 
adding itis to the name of the part af- 
fected, thus meningitis or inflamma- 
tion of the meninges, tonsilitis or in- 
flammation of the tonsils, etc. 

Inguinal Canal, A canal situated in the 
groin, through which the spermatic 
cord passes. 

Inhalation, The breathing of steam or 
some medicated vapor. 

Injection, A quantity of liquid thrown 
into a cavity of the body for medicine 
or nourishment. 

Inoculation, The communication of a 
disease to a person by inserting virus 
into his skin or blood. 

Inspiration, The act of inhaling or 
breathing in air. 

Intention. To heal by first intention is 
to heal without suppuration. 

Intercostal, Between the ribs, used of 
muscles, nerves etc. 

Intermittent, With an interval. Ap- 
plied to a fever that goes and returns, 
or to a pulse that misses a beat. 

Intestine, The canal or tube extending 
from the stomach to the anus. 

Intervertebral, Located between the 
vertebrae. 

Intrapelvic, Within the pelvis. 



828 



GLOSSARY. 



Involve, To implicate or include. 

Involution, Contraction 10 natural size. 

Irritants, Things that irritate, causing 
pain, heat or tension. 

Koumis, A liquor obtained from fer- 
menting mare's or camel's milk. 

Labor, Childbirth. 

Labia, Lips. 

Lacerate, To wound ; to tear. 

Lachrymal, Pertaining to tears, or se- 
creting or conveying tears. 

Lactation, The time of giving suck ; 
nursing. 

Lacteal, One of the vessels which take 
up and convey milk. 

Lanugo, The coat of downy hair cover- 
ing the human fetus. 

Laryngitis, Inflammation of the lar- 
ynx. 

Latrine, A camp privy. 

Laxative, That which produces loose- 
ness of the bowels ; gently cathartic. 

Lesion, A morbid change in the tex- 
ture of an organ; an injury of struc- 
ture caused by disease. 

Leucocite, A white blood cell. 

Leucorrhoea, A uterine catarrh accom- 
panied by a whitish or yellowish dis- 
charge from the vagina. 

Levator, That which lifts up or erects. 

Libidinous, Impure ; licentious. 

Ligament, A strong substance binding 
one bone to another. 

Ligature, A cord for tying a blood ves- 
sel. 

Lithemia, A condition of the blood in 
' which uric acid is found in excess. 

Lithiasis, The formation of stony con- 
cretions in any part of the body. 

Lumbar, Near the loins, or back part of 
the waist. 

Lumbosacral, Pertaining to the sacral 
region of the back. 

Lymph, A colorless animal fluid found 
in the vessels called lymphatics. 

Lymphoidal, Having the nature of 
lymph. 

Macerate, To soften and separate the 
parts, as by steeping. 

Malaise, The discomfort often experi- 
enced before or at the beginning of a 
disease. 

Malaria, The poison caused by the 
germ Plasmodium malaria. 

Malignant, Virulent, tending to cause 
death. 



Malpighi, The discoverer of the glands 
in the kidneys which secrete the urine, 
in honor of whom they are called the 
Malpighian glands. 

Mammary Glands, The breasts or 
milk-secreting organs. 

Marasmus, A wasting of the flesh with- 
out any apparent disease. 

Mastoid, Resembling the breast or nip- 
ple of a woman. 

Mastication, The act of chewing the 
food and mixing it with the saliva. 

Meatus, A duct or passage of the body. 

Meconium, The first feces of infants. 

Medulla, The central axis, pith or mar- 
row. 

Medullary, Pertaining to the marrow. 

Melanotic, Pertaining to a morbid de- 
posit in the organs of the body. 

Menorrhagia, An excessive menstrual 
discharge. 

Menses, The periodic flow of bloody 
fluid from the mucous lining of the 
uterus. 

Menstruation, The discharge of the 
menses. 

Mesentery, A membrane which holds 
the intestines in position. 

Metastasis, A sudden change of disease 
from one part of the body to another. 

Metastatic, Of or pertaining to change 
of substance or place. 

Metritis, Inflammation of the middle 
coat of the uterus. 

Microbe, A microscopic organism ; a 
bacterium. 

Micro-organism, A disease germ, a mi- 
crobe. 

Microscopy, The art of using the micro- 
scope. 

Micturition, The act of urinating, or 
making water. 

Mobility, Easily movable. 

Mucus, The sticky, slimy fluid secreted 
by the mucous membranes. 

Mucous Membrane, The thin web-like 
lining of the canals and cavities which 
secretes a mucilaginous fluid by which 
it is kept lubricated. 

Mummified, Dried or become like a 
mummy. 

Narcotics, Medicines which by their op- 
eration on the brain and nerves dimin- 
ish sensibility and induce sleep. 

Nares, The nostrils. 



GLOSSARY. 



829 



Nausea, Sickness of the stomach with 

a tendency to vomit. 
Necrosis, The death of a piece of tissue. 

The term is applied to bones as gan- 
grene is to flesh. 
Nephritis, Inflammation of the kidneys. 
Neuritis, A disease of the nerves. See 

page 733, Ner. Dis. 
Neurologist, One who describes the 

nerves. 
Neuron, A nerve cell and its attached 

fiber. 
Neurosis, Pl. Neuroses, A disease of 

the nerves without lesion of the parts, 

as neuralgia. 
Nodule, A rounded mass. 
Normal, Healthy, natural. 
Noxious, Harmful ; unwholesome. 
Nuclei, Plural of nucleus. A kernel 

or center about which anything is 

formed or collected. 
Nucleolus, A little nucleus, a nucleus 

of a nucleus. 
Nutrients, Substances which nourish. 
Nutrition, The process by which food 

is digested and assimilated. 
Obese, Very fat or corpulent. 
Obstetrics, The science of midwifery. 
Occlusion, The act of closing up, or the 

state of being closed. 

Occlusional, That which covers or 

closes up an opening. 
Ocular, Pertaining to the eye. 
Olfactory, Of the sense of smell. 
Ophthalmia, Inflammation of the eye. 
Opthalmic, Belonging to the eye. 
Ossification, The process of changing 

into bone. 
Ovarian, Pertaining to the ovaries. 
Opiate, A medicine which produces 

sleep. 

Ovoid, Shaped like an egg. 

Ovulation, The process of discharging 
an ovum by an ovary. 

Ovum, The egg or body formed by the 
female in which after impregnation 
the fetus develops. 

Oxidation, The process of uniting with 
oxygen. 

Palliative, That which alleviates pain, 

but does not cure. 
Paludal, Pertaining to marshes or 

swamps. 



Pancreas, One of the digestive organs; 
the sweetbread. 

Pancreatin, One of the active ferments 
of the pancreatic juice. 

Papilloma, A kind of tumor. 

Papillomatous, Of the nature of a pa- 
pilloma. 

Papular, Covered with pimples. 

Paralysis, Loss of voluntary motion; 
palsy. 

Parasite, A plant or animal which lives 
upon and gets its nourishment wholly 
or in part from some other plant or 
animal. 

Parasitic, Like a parasite. 
Parenchyma, The spongy porous mass 
of an organ. 

Parietes, Walls, as the abdominal pari- 
etes. 

Pathogenic, Generative of diseases. 
Paroxysm, A sudden increase of symp- 
toms ; a fit. 

Pathological, Pertaining to pathology 
or knowledge of diseases. 

Pathognomonic, Characteristic of dis- 
ease. 

Pathology, The science of diseases. 

Pelvis, The bone framework of the 

lower part of the body, enclosing the 

internal urinary and sexual organs. 
Pepsin, A ferment formed in gastric 

juice in the colon. 
Peptinoid, A compound formed by the 

action of pepsin upon nitrogenous 

food. 

Perennial, Perpetual. 

Pericardium, The membrane which en- 
closes the heart. 

Perineal, Pertaining to the perineum. 

Perinaeum, The space at the lower end 
of the body between the anus and the 
genital organs. 

Periodic, Returning regularly after a 
certain period of time. 

Periosteum, The membrane surround- 
ing the bones. 

Peripheral, Pertaining to the periphera 
or outside. 

Peristalsis, An involuntary, contractile, 
successive movement of the alimentary 
canal, whereby its contents are gradu- 
ally driven toward the point of their 
expulsion. 

Peritoneum, A serous membrane lining 
the abdominal walls and forming the 



830 



GLOSSARY. 



outer coat of the stomach, intestines, 
liver, spleen, ovaries, uterus and blad- 
der. 

Perspiration, Sweat. 

Pessary, An instrument for holding the 
uterus in its natural position. 

Peyerian Glands, The agminate glands 
of the small intestine, so named in 
honor of Peyer, their discoverer. 

Phenomenon, Pl. Phenomena, any- 
thing remarkable. 

Phlegmatic, See page 562. 

Phrenic, Pertaining to the diaphragm. 

Phthisis, Consumption of the lungs. 

Pigment, Any organic coloring matter. 

Pigmentation, Discoloration by the de- 
posit of pigment in the cells. 

Placenta, The afterbirth; the soft disc 
by which the mother is connected with 
the fetus and through which she sup- 
plies it air and nourishment. 

Plasma, The liquid part of the blood as 
distinguished from its corpuscles. 

Plethora, The state of being over full ; 
excess of blood. 

Pleura, The membrane which lines the 
cavity of the chest and encloses the 
lungs. 

Plexus, A network of vessels or nerves. 

Polyp, A many footed animal. 

Polypoid, Like a polypus, or tumor hav- 
ing a small base. 

Popliteal, Back part of the knee joint. 

Posterior, Situated behind. 

Post-mortem, After death. 

Potential, That which may be possible. 

Precordial, Pertaining to the parts be- 
fore the heart. 

Pregnant, Being with young. 

Prepuce, A prolongation of the skin 
covering the penis or clitoris. 

Procreation, The begetting of young. 

Prolapsus, A falling down of some in- 
ternal part of the body. 

Proliferate, To grow by multiplication 
of cells or elementary parts. 

Proprietary, That belonging to a pro- 
prietor or owner. 

Prostatic, Pertaining to the prostate. 

Prostate, A gland surrounding the 
urethra, just below the neck of the 
bladder, in males. 

Protean, Very changeable. 

Proteid, A food-stuff whose principal 
service is to renew or build up the 
soft tissues of the body. 



Protoplasm, The albuminoid substance 
constituting the physical basis of life. 

Protozoa, A primary division of the ani- 
mal kingdom, consisting of a single 
cell, or group of cells. 

Protuberant, Extending outward; 
protruding. 

Psorospermosis, A kind of parasitic dis- 
ease. 

Psychic, Psychical; Pertaining to the 
mind or soul. 

Ptomaine, An alkaloid, usually poison- 
ous, derived from decomposing animal 
matter, or produced by disease germs 
in a living body. 

Puberty, The age at which persons be- 
come capable of begetting or bearing 
children. 

Pubes, The part of the lower portion 
of the body that is covered with hair 
at puberty. 

Puerperal, Pertaining to childbirth. 
Pulmonary, PertLning to the lungs. 
Pulsation, Throbbing, as the beating of 
the pulse. 

Purge, To cause frequent and excessive 
evacuations of the bowels. 

Purulent, of the nature of pus or mat- 
ter. 

Pus, Purulent matter; the thick, sticky 
fluid formed by the process of suppu- 
ration. 

Pustular, Covered with pustules or 

blisters. 
Putrefaction, A process of decay 

caused by minute organisms. 
Putrescible, A body that decomposes at 

a certain temperature. 
Pyrogallic, Obtained from gallic acid 

by the action of heat. 
Pylorus, The opening in the stomach 

through which food passes into the 

intestine. 

Rectal, Pertaining to the rectum or 
lower part of the large intestine. 

Reflex, Turned or thrown backward; 
reactive; a result of reaction. 

Regeneration, To form into a new or 
better state. 

Regurgitant, Pertaining to regurgita- 
tion. 

Regurgitation, An easy vomiting of 

food. 
Renal, Pertaining to the kidneys. 
Remittent, That which has remissions, 

or abates from time to time, applied 



GLOSSARY 



831 



to a fever which does not quite dis- 
appear, and which increases again and 
again. 
Residuum, That remaining after a proc- 
ess of separation. 

Respiratory, Pertaining to respiration 
or breathing. 

Retch, To try to vomit ; to strain. 

Rete, A vascular network. 

Reticular, Like a net. 

Retina, The expansion of the nerve of 
sight, within the eye. on which the 
images of external objects are thrown. 

Retixitis, Inflammation of the retina. 

Rigor, A chill ; a sudden coldness intro- 
ductory to many diseases. 

Sacral, Pertaining to the sacrum. 

Sacrum, The triangular bone forming 
the back part of the pelvis and termi- 
nating the backbone ; the lowest part 
of the spine. 

Salines, Medicinal salts, mostly laxa- 
tive. 

Saliva, Secretion of the salivary glands; 
spittle. 

Salivation, A continued and unhealthy 
flow of saliva. 

Salubrious, Favorable to health; 
healthy. 

Saxitation, Measures to secure and 
preserve health. 

Sanious, Thin, serous and slightly 
bloody, as the sanious discharge of 
an ulcer. 

Scarletixoid, Like scarlet fever. 

Sclerosis, The hardening or thickening 
of a tissue. 

Sclerotic, Hard, firm; the white outer 
coat of the eye. 

Scrotum, The bag containing the testi- 
cles. 

Sebaceous, Like fat ; pertaining to fat. 

Secrete, To form or separate from the 
circulating fluids of the body. 

Secretiox. That which is secreted, or 
produced from the circulating fluids. 

Secretory, Pertaining to that which se- 
cretes. 

Sedatives, Medicines which diminish 
the power and velocity of the circula- 
tion of the blood by their action on the 
heart and large arteries. 

Sedextary, Accustomed to sitting. 

Senility, Old age. 

Sensory, Connected with sensation. 

Sepsis, Decomposition, rot. Contamina- 



tion of an animal organism from ill- 
conditioned wounds, abscesses, or 
other breeding places of bacterial 
germs. 

Septic, Pertaining to any substance that 
produces putrefaction. 

Septicemia, or Septemia, A morbid 
condition of the blood due to the ab- 
sorption of poison from putrefaction. 

Sequellae, Disorders resulting from a 
disease. 

Serous, Watery. 

Serous Membraxes, The membranes 
lining the closed cavities and secreting 
a watery, lubricating fluid. 

Serum, The clear yellowish liquid that 
separates from the clot when blood 
coagulates. 

Sigmoid Flexure, An S-shaped curve 
in the large intestine. 

Sinistra, The left hand. 

Sitz-bath, A hip-bath. 

Specific, That which exerts special ac- 
tion in the prevention or cure of dis- 
ease. 

Specific Disease, A communicable dis- 
ease ; a disease caused by living germs. 

Spermatozoa, The male fertilizing ele- 
ment of an animal. 

Spinal, Pertaining to the backbone. 

Splenic, Pertaining to the spleen. 

Sphincter, A muscle which by contract- 
ing lessens or closes the opening of an 
organ. 

Sputa, The salival discharges from the 
mouth, including mucus from the 
nose, throat and lungs. 

Static, Acting by weight only, without 
motion. 

Sterile, Barren, unfruitful. 

Stertor, Snoring ; hence stertorous 
breathing. 

Stimulant, An agent which increases 
the vital activity of an organ. When 
this effect is produced in all the organs 
or functions the agent is called a gen- 
eral stimulant ; when limited to one or 
two organs, a local stimulant ; when 
it affects only the part to which it is 
applied it is an irritant. 

Strangury, Scanty or painful urination. 

Striate, To mark with lines or grooves. 

Stricture, A contraction in some pas- 
sage of the body. 

Stroma, The tissues forming the foun- 
dation or framework upon which the 
essential structures of an organ rest. 



832 



GLOSSARY. 



Styptic, Astringent; tending to check 
bleeding. 

Subcutaneous, Under the skin ; hypo- 
dermic. 

Subinvolution, A hindered or incom- 
plete return to normal dimensions, as 
of the uterus after childbirth. 

Suppository, A solid introduced into the 
rectum or vagina to be dissolved there 
for purposes of medication. 

Suppuration, The process of forming 
pus. 

Suture, A stitch or fastening to unite 
the lips of a wound. 

Symphysis Pubes, The union of the 
two front pelvic bones. 

Syncope, Fainting. 

Syphilitic, Like syphilis; infected with 
syphilis. 

Systemic, Pertaining to the system or 
parts of the body. 

Tampon, A plug introduced into a nat- 
ural cavity of the body 10 prevent dis- 
charges. 

Tenesmus, A continued desire to empty 
the bowels or bladder, when there is 
little or nothing to be discharged. 

Tension,, Stretch or strain. 

Tentacle, An organ of feeling or mo- 
tion of an invertebrate animal. 

Therapeutics, That branch of medicine 
which relates to the treatment of dis- 
eases. 

Thoracic, Pertaining to the thorax or 
chest. 

Thyroid Cartilage, A part of the 
darynx; Adam's apple. 

Thyroid Gland, A substance or gland 
on the upper part of the windpipe. 

Tonic, That which gives tone or 
strength to the system. 

Toxaemia, Poisoning of the blood. 

Toxic, Poisonous. 

Toxine, Poison ; especially poison pro- 
duced by the action of germs. 

Trachea, The windpipe. 

Transfusion of Blood, The injection of 
blood from the veins of one into those 
of another. 

Trait matic, Caused by wounds or in- 
juries. 

Trophic, Of or pertaining to nutrition. 

Tubercle, A small granular tumor or 
nodule resulting from the presence of 
the bacillus tuberculosis. 
Tuberculosis, A diseased condition of 



the system due to the presence of 
tubercles. 

Umbilical Cord, The cord-like struc- 
ture which conveys blood from the 
placenta to the fetus ; the navel cord. 

Umbilical Region, The central part of 
the abdomen, round the umbilicus. 
Above it is the epigastric region, and 
below it the hypogastric. 

Umbilicus, The navel. 

Uraemia, An accumulation in the blood 
of poisons of the urine. 

Urea, One of the constituents of urine, 
separated from the blood by the kid- 
neys. 

Ureter, The tube or duct which conveys 
the urine from the kidneys to the 
bladder. 

Urethra, The canal by which the urine 
is discharged from the bladder. 

Urticarial, Stinging, as with nettles. 

Uterine, Pertaining to the uterus. 

Uterus, The womb. 

Vagina, The canal leading from the 
vulva to the womb. 

Vaginal, Pertaining to the vagina. 

Vaginitis, Inflammation of the lining 
membrane of the vagina. 

Varicose, Enlarged, as varicose veins. 

Vascular, Pertaining to the vessels of 
the body, as of veins, arteries, etc., or 
consisting of such vessels. 

Vaso-motor, See page 706. 

Venereal, Pertaining to sexual inter- 
course. 

Venomous, Poisonous. 

Vernix Caseosa, A greasy protecting 
coat covering the skin of the fetus in 
the later months of pregnancy. 

Vertebrae, The twenty- four bones 
which constitute the spinal column. 

Vertebral, Pertaining to the vertebrae 
or backbone. 

Vertigo, Giddiness, dizziness. 

Vesicle, A cyst, sac, or cell. 

Vesicular, Of or pertaining to vesicles, 
or small sacs or cysts. 

Virus, Poisonous matter, the infection 
or contagion of disease. 

Virulent, Extremely poisonous. 

Viscera, Two or more of the internal 
organs, more particularly the intes- 
tines. 

Vivified, Quickened with life. 

Vulva, The external generative organs 
of the female. 



INDEX 



Abdominal Breathing, 38. 

— Distention with gas, 268. 

— Protrusion, 39. 
Abortion, 525. 

— Tendency to, caused by tobacco, 58. 
Accidents, see emergencies, 175. 

— Bite of mad dog, 204. 

— Bites and stings of insects, 202. 
Of serpents, 202. 

— Bruises, 228. 

— Burns and scalds, 199. 

— Choking, 193. 

— Cuts, 220. 

— Dislocations, 228. 

— Drowning, 194. 

— Fainting, 793. 

— Foreign bodies in the ear, 417. 
In the eye, 409. 

— Fractured bones, 225. 

— Frost bites, 197. 

— Hemorrhage from wounds, 220. 

— Hernia, 230. 

— Lacerations, 220. 

— Lightning or electric shock, 201 

— Objects swallowed, 193. 

— Poisoning, 175. 

— Rupture, 230. 

— Sprains, 226. 

— Sunstroke or heat stroke, 198. 

— Suffocation from smoke or gas, 197. 
Acetanilide, 131. 

Acid, boric, 133. 

— Carbolic as an antiseptic, 132. 

As a disinfectant, 113. 

Poisoning, 190. 

— Hydrochloric (muriatic) poisoning, 

177. 

— Hydrocyanic, poisoning, 177. 

— Mineral, poisons, 176. 

— Nitric, poisoning, 177. 

— Prussic, poisoning, 177. 

— Sulphuric, poisoning, 177. 
Acne, 637. 

Action of the bowels, 241. 
Aconite, 132. 

— Poisoning, 184. 
Active period of life, 572 
Adenoid growths, 388. 



Administration of food to infants, 448. 
To the sick, 172. 

— Of medicines, 148. 

Age at which the teeth appear, 349, 

351. 

— Which man should attain, 23. 
Air, 52. 

— A medium of infection, 49. 

— Amount of breathed by an adult, 60. 

— Borne diseases, 49. 
The care of, 161. 

— Cells, 359. 

— Currents as atmospheric purifiers, 56. 
As factors of disease, 56. 

— Damp, injurious to health, 54. 

— Ground and contaminated, to be 

avoided, 60. 

— How to get the full benefit of pure, 

40. 

— Composition of, 52. 

— Residual, 359. 

— Space, amount of, needed in rooms, 

61. 

— Standard of purity of, 52. 

— Tidal, 359. 

— Why damp, is lighter than dry, 54. 
Albuminoids, 236. 

Albuminous foods, 80. 
Albumin-water, 171. 
Alcohol, 96. 

— Effects of, upon the brain, 102. 
Upon the heart and kidneys. 

101. 

Ijpon the liver, 100. 

Upon the stomach, 98. 

Alcoholic insanity, 817. 
Alcoholic remedies, 129. 
Dangers in the use of, 84. 

— Strength of liquors, 129. 
Ale as a beverage, 83. 
Alimentary canal, 235. 
Alkalies, poisoning by, 178. 
Alopecia, 683. 

— Areata, 685. 

— Senile, 684. 

Altitude, influence of, upon health, 53. 

— May aggravate heart disease, 54. 

— May prevent or cure lung disease, 54. 
Altona, Water supply of, 70. 



53 



833 



834 



INDEX. 



Alum, 143. 

— As an emetic, 136. 
Amaurosis from smoking, 106. 
Ammonia, poisoning, 179. 
Amniotic fluid, 506. 

Amyl nitrite, 143. 

Anatomy of the skin, 629. 

Ancestral errors increased in the off- 
spring, 22. 

Anemia, 355. 

Aneurism, 353. 

Angina pectoris, 352. 

Animalisms, too often lived in by man, 
22. 

Ankle-drop, 763. 

Anteflexion, 607. 

Anteversion, 607. 

Anthelmintics, 142. 

Anthrax, 673. 

Antidotes, classes of, 176. 

Antipyretics, 129. 

Antipyrin, 131. 

Antiseptics, 132. 

Antitoxine, how prepared, 282. 

— Treatment of diphtheria, 281. 
Of disease, 211. 

Aorta, the, 343. 

Aperients, 139. 

Aphasia, 44. 

Apomorphine, 127. 

Apoplexy, see Intracranial Hemorrhage, 

751- 
Apothecary's weights, 148. 
Appendicitis, 253. 
Aptha, 558. 

Apthous, stomatitis, 453. 
Arnica, 142. 
Arachnoid, the, 717. 
Arrectores pilorum, 633. 
Arsenic, 127. 

— Forms of, 179. 

— Poisoning, 179. 
Arterio sclerosis, 354. 
Artesian water, 67. 
Arthritis rheumatoid, 324. 
Artificial foods, 442, 542. 

— Respiration, 196. 
Asafetida, 143. 

Ascaris lumbricoides, 422. 

Asepsis, 401. 

Asphyxia, from carbon monoxide, 57. 

— From drowning, 194. 
Asthma, 360. 
Astigmatism, 412. 

Asylum, purposes of the, 819. 
Ataxia locomotor, 747. 
Athlete, the, 45. 

— Dangers to from ceasing to exer- 

cise, 46. 
Heart or lung failure, 46. 

— The college, 46. 

Athletes who die from heart trouble, 36. 
Atropine poisoning, 184. 



Auto-infection, 23, 486. 
Auto-suggestion, a cause of disease, 778. 
Auricles, the, 342. 

B. 

Baby, size and weight of the, 432. 
Bacilli, Bacillus, 212. 
Bacillus tuberculosis, 370. 
Bacteria, a cause of disease, 49, 210. 

— Agency of in sand filtration. 69. 

— And equivalent terms, 212. 

— As aids in diagnosis, 214. 

— Destroyed by disinfection, no. 

— How they grow and multiply, 213. 
Produce disease, 214. 

— In putrefaction, 215. 

— In teeth, 91. 

— In water, 67. 

— In wounds, 215. 

— Size of, 212. 

— The discovery of, 209. 

— The temperature which destroys, 

213. 

— Universal prevalence of, 214. 

— Useful varieties of, 214. 
Bag of water, the, 506. 

Balance between the activities, 23. 

Balanced rations, 88. 

Baldness, 635, 683. 

Ballotment, 510. 

Balsam of copiaba as a diuretic, 138. 

Barber's itch, 664. 

Barley water, 169. 

Bathing in a lake or stream, 24. 

— Infants, 438. 

Bath, the free public, 77. 

— The rain, 77. 

— The Roman, 76. 

— Things to be remembered about the, 

78. 

— The Turkish, 580. 
Bed bugs, 658. 

Bedding, how to disinfect, 120. 

Bed sores, 158. 

Beef, composition of, 81. 

— Juice, 169. 

For infants, 447. 

— Tea, 169. 

Beer as a beverage, 83. 
Belladonna, 144. 

— The, group, 184. 

— Poisoning by, 184. 
Beverages, 82. 

Bicycle, advantages and disadvantages 
of the, 40. 

— How to adjust the saddle of the, 44. 

— Improper saddles and positions on 

the, 41. 

— Insidious injuries wrought by the, 42. 
Bichloride of mercury as an antiseptic, 

134- 
As a disinfectant, 113. 



INDEX. 



835 



Biliary concretions, 311. 

Bills of fare for the healthy, 88. 

— For the convalescent, 172. 
Bismuth, subnitrate, 133. 
Bites and stings of insects, 202. 

— Of serpents, 202. 
Bitters, 127. 

Black heads, 634. 

— Measles, 479. 

Bladder, abnormal conditions of the, 
619. 

— Functional diseases of the, 617. 

— Organic diseases of the, 621. 

— Paralysis of the, 619. 

— Worm, the, 428. 
Blebs, 631. 

Bleeding, how to stop, 220. 
Blood, circulation of the, 342. 

— Composition of the, 344. 

— Diseases of the, 353. 

— Vessels, diseases of the, 353. 
Blush, 654. 

Blue rocket, poisoning by, 184. 

Body lice, 655. 

Boiling to purify water, 72. 

Boils, 670. 

Bones, broken, 224. 

Boots and shoes, how to disinfect, 121. 

Borax, boric acid, 133. 

Bowels, movements of, in infancy, 458. 

Brachial plexus, the, 712. 

Brain, anemia of the, 725. 

— Centers, 714. 

— Congestion of the, 725. 

— Convolutions of the, 709. 

— Cortex of the, 709. 

— Diseases caused by alcohol, 102. 

Developmental influences in, 726. 

Exciting causes of, 726. 

Predisposing causes of, 725. 

— Dropsy of the, 755. 

— Functional diseases of the, 725. 

— Hemorrhage of the, 724. 

— Improved by moral exercise, 35. 

— Influence of tobacco upon the, 106. 

— Subdivisions of the, 707. 

— Surface of the, 709. 

— Tumors of the, 724, 754. 
Brandy as a beverage, 84. 
Bread, graham, for diabetics, 330. 

— Wheat, value of, as food, 85. 
Breast, abscess of the, 550/ 
Breathe, how we should, 37. 
Breathing abdominally, 37. 

— Exercises, 374. 

— The function of, 358. 

— Thoracically. 37. 

— Through the mouth, effects of, 385. 

— To develop the lungs, 37. 
Bright's disease, 334. 
Bromide of potassium, 143. 
Bromidrosis, 679. 



Bronchi, the, 358. 
Bronchial asthma, 362. 
Bronchioles, the, 358. 
Bronchitis, 360. 

— Chronic, 361. 
Broncho-pneumonia, 368. 

With measles, 478. 

Brownsville, malaria at, 271. 
Bruises, 227. 

— Of the new born, 554. 
Bubo, syphilitic, 689. 
Buchu, 138. 

Building sites, two contrasted, 26. 

Bulb, the, 750. 

Bulbar paralysis, 750. 

Bullae, 631. 

Burns and scalds, 199. 



Caffeine, 128. 

Calcareous degeneration, 723. 
Calculus, salivary, 94. 
Caloric, the unit of heat, 87. 
Camp, care of the, 24. 

— Food and water supply of the, 24. 

— Hygiene of the, 23. 

— Surgeon to have charge of the mili- 

tary, 25. 
Camphor, 144. 
Canaliculi, the, 405. 
Cancer, 240. 

Canker sore mouth, 453. 
Capillaries, the, 343, 359. 
Carbo-hydrates, 80. 
Carbolic acid as an antiseptic, 132. 

As a disinfectant, 113. 

Poisoning, 190. 

Carbon dioxide, 53. 

A product of explosions, 57. 

Plow detected, 60. 

Precautions against, in wells, 57. 

Quantity of, exhaled by an adult, 

60. 
Carbon monoxide, 57. 
Carbuncles, 672. 
Carburetted hydrogen, 57. 
Care of the sick, 157. 

Sick-room, 161. 

Carpets, dangers from, 29. 

— How to disinfect. 121. 
Castor oil, 139. 
Catalepsy, 774. 

Catarrhal inflammation of the intestines, 
464. 

— Croup, 486. 

— Stomatitis, 451. 
Catarrh, common, 386. 

— Dry,386. 

— In adults, 384. 

— In the new born, 558. 

— Mucous, caused by alcohol, 99. 



836 



INDEX. 



Cathartics, 138. 

— What to take, 140. 
Caustic potash poisoning, 178. 

— Soda poisoning, 178. 

Caution in the use of germicides, 658. 

Cecum, the, 240. 

Cell, all life begins in a, 21. 

Cellar, ventilation and cleanliness of the, 

28. 
Cells, destroyed, must be removed, 23. 

— Of the brain, how made better, 30. 
Centers of nervous action, 713. 
Cereal foods, partly digested by heat, 

447- 
Cerebellum, the, 707. 
Cerebro-spinal axis, 705. 

Fluid, 755. 

Meningitis, 756. 

Cerebrum, the, 707. 

— Diseases of the, 754. 
Cerium oxalate, 144, 
Cephalhematoma, 554. 
Cervicitis, 599. 
Cervico-occipital nerves, 730. 
Cervix, the, 497. 

Cess pools, how to disinfect, 121. 

Chafing, 653. 

Chalazii, 401. 

Chancre, 688. 

Change of life, 624. 

Changes in the organism caused by 

pregnancy, 506. 
Changing the clothing of the sick, 157. 

— Sheets, 157. 

Charcoal not fit for filters, 68. 

Charcoal as an antiseptic, 135 

Chemical disinfectants, 112. 

Chicken-pox, 480. 

Chilblains, 666. 

Cnildbirth, convalescence from, 544. 

— Effects of, 545. 
Child-bed fever, 546. 

Child, care of the new born, 538. 

— Clothing of the new born, 542. 
Children, diseases of, 431. 

— Injured by poor ventilation, 61. 

— Parents should play with their, 36. 

— Shape and proportion of at birth, 

433- 

— Tissue building in, 35. 
Chloasma, 677. 

Chloral hydrate, 141. 

Poisoning, 190. 

Chloride of lime as a disinfectant, 114, 

134- 
Chlorine, 114. 
Chloroform, 145. 
Chlorosis, 571, 356. 
Cholera epidemic at Hamburg, 71. 

— Infantum, 469. 

— Morbus, 247. 
Chologogues, 140. 



Chorea, 767. 
Chyme, 2.36. 
Cicatrix, 631. 
Cigarette smoking, 105. 
Cigar makers, average life of, 58. 
Cimex lectularius, 658. 
Circulation, the collateral, 718. 
Cirrhosis, atrophic, 100. 
Cisterns, how to construct, 74. 
Clap, 696. 
Clavus, 667. 

Cleanliness, surgical, 219. 
Climate, influence of, upon diseases, 56. 

— The, required by consumptives, 54, 

373- 
Clitoris, the, 496. 
Clothing, how to disinfect, 119. 

— Of girls and women, 563. 

— Of nurses and physicians, how to 

disinfect, 122. 
Cocaine, 144. 

— Poisoning, 188. 
Cocainized vaseline, 404. 
Cocci, 212. 

Cochlea, the, 413. 

Cocoa and chocolate as beverages, 83. 

Cod liver oil, 126. 

Coffee, as a beverage, 83. 

Cold on the lungs, 360. 

— Sores, 643. 
Colds, causes of, 381. 

— Prevention of, 382. 
Colic, 249. 

— Hepatic, 311. 

— In infants, 461, 558. 
College athletics, 46. 
Collodion, 144. 
Colon, the, 240. 
Coma, 793. 
Comedo, 634. 

Condensed milk, unfit for infants, 446. 
Conditions, transmission of debased, 21. 
Confinement, importance of cleanliness 

during, 546. 
Congestion of the bladder, 621. 

— Of the liver, 308. 

— Of the brain, 725. 
Conium poisoning, 186. 
Conjunctivitis, 401. 
Constipation, 240. 

— In infancy, 462. 

— In the new born, 559. 
Constitutional syphilis, 689. 
Consumption, 370. 

— Creosote as a remedy for, 376. 

— Of the spinal nerves, 747. 

— Quick, 378. 

— To prevent the spread of, 50. 
Consumptives, the best climate for, 373. 
Consumptive parents, 22. 
Contagious diseases, 49. 

Care of, 164. 



INDEX. 



837 



Contamination of water, dangers from 

the, 66. 
Contracted kidney, 101. 

— Liver, ioo. 

Contrasts in masculine and feminine 

development, 573. 
Control of the breath, 393. 
Convalescence, the diet during, 172. 
Convolutions of the brain, 709. 
Cooking for the sick, 167. 
Copper poisoning, 188. 
Corns, 667. 
Corpses, preparation of, for burial, 165. 

— How to disinfect, 119. 
Corpulency, 331. 

Corpus callosum, 707. 

Corpuscles, the red and white, 344. 

Corrosive sublimate as a disinfectant, 

"3- 

Corsets, causes of uterine displacement, 
38. 

— Sources of weakness, 39. 
Cortex of the brain, 709. 

— Of the ovary, 501. 

Cost of various bills of fare, 88. 

— Versus health in the home, 26. 
Costume of the nurse, 155. 
Cotton mill operatives, 59. 
Coughing, 360. 

Cow-pox, 290. 

Cows' milk, how modified for infants, 

443- 
Crabs, 406, 656. 
Cranial nerves, 705, 711. 
Craniotabes, 491. 
Creolin as a disinfectant, 113. 
Creosote, 132. 

— As a remedy for consumption, 376. 
Cresol, as a disinfectant, 113. 
Croup, membraneous, 278. 

— Spasmodic or false, 486. 
Crusts, 631. 

Cubebs, 138. 
Cutting teeth, 449. 
Cystitis, 621. 



Dandelion, 145. 

Dandruff, 635. 

Deafness, can it be cured? 414. 

Deaths, premature, 23. 

Decoction, 125. 

Decussation of nerves, 708. 

Defecation, 439. 

Defective sweat, 678. 

Deformed teeth, how caused, 92. 

Defeneration of nerves, 723. 

Delirium tremens, 102. 

Delusions, 801. 

Dementia. 811. 

Density of the air a factor of health, 53. 

Dental arch, preservation of the, 92. 



Dentition, 449. 

Deodorizers, not disinfectants, 113. 

Dermatitis, 651. 

— Medicamentosis, 652. 
Desquamation, 631. 

Development, defective from lack of ex- 
ercise, 30. 

— Faulty because of corsets, 38. 

— Neglected by man, 22. 

— Of both right and left sides, 44. 

— Of heart and lungs. 36. 

— Of man in line with his activities, 47. 

— Of muscle does not develop mind, 46. 

— Of muscle a secondary matter, 36. 

— Of the nerves, 44. 

— The value of will power in, 45. 
Diabetes, 328. 

Diaphragm, the, 358. 
Diarrhea, 442. 

— Acute, 443. 

— Chronic, 245. 

— In the new born, 558. 

— Of infants, 463. 
Diastole, 344. 
Diet, 80. 

— Fluid, 588. 

— For the aged, 591. 

— For the school girl, 562. 

— For the spare, 590. 

— In disease, 168, 587. 

Of the stomach and bowels, 170. 

— In health, 84. 

— In infancy and childhood, 561. 

— In obesity, 333, 590. 

— In wasting diseases, 170. 

— Meaning of the term, 239. 

— Vegetable, 590. 
Digestion, 235. 

— How to aid, 90. 

— In the new born, 553. 
Digestibility of various foods, 89. 
Digestive troubles, how to locate, 237. 
Digitalis, as a diuretic, 137. 

— As a heart stimulant, 128. 

— Poisoning, 190. 
Diplococci, 212. 
Diphtheria, 278. 

Discoloration from bruises, 228. 
Discolorations of the new born, 555. 
Disease, a logical result of what, 23. 
Diseases, air-borne and contagious, 49. 

— Causes of, 49. 

— Not hereditary, 22. 

— Peculiar to certain temperatures, 55. 

— Precautions against the spread of, 

— Water-borne, 49. 
Disinfectants, patent, 123. 

— Quantity of, required, 118. 

— Various kinds of. 112. 

— What to use and how, 117. 

— Where to apply, in. 



838 



INDEX. 



Disinfecting solutions, 115. 
Disinfection and disinfectants, no. 

— High temperature an aid in, 117. 

— Principles of, in. 

— Time an element in, 117. 
Dislocations, 228. 

— Of the back and neck, 749. 
Displacement of organs invites disease, 

39- 

— Of the uterus, 606. 
Distillation of water, 72. 
Diuretics, 137. 

Dogs, danger from, fed upon slaughter 
house refuse, 427. 

— May spread disease, 51. 
Dose list, 150. 

Doses for children, 149. 
Drainage, house, 26. 
Drastic purgatives, 139. 
Draw sheets, 158. 
Drinking at meals, 238. 
Dropsy, 339. 
Dropper, a, 404. 
Drowning, 194. 
Drug eruptions, 652. 
Drunkenness, 103. 
Dry baths, 179. 

— Water closets, 63. 

Dust, a medium of infection, 50. 

— Danger from exposing food to, 56. 

— How it may be kept out of rooms 

61. 

— In factories, 58. 

— Of country and city contrasted, 56. 
Dyeing the hair, 682. 

Dura mater, the, 717. 
Dysentery, 246. 
Dyspepsia, chronic, 238. 

— In infants, 455. 



Ear, the, 413. 

— Abscess of the, 414. 

— Boils, 415. 

— Things not to be done to the, 417. 
Earache, 414. 

Echinococcus, 419. 
Eczema, 648. 

— Of the scalp, 635. 
Egg-nog, 170. > . 
Eggs, how to cook for the sick, 167. 
Egg-water, 170. 

Electricity in treating disease, 581. 

Electric shocks, 201. 

Embolism, 751. 

Emergencies, 175. 

Emergency or first aid packets, 217. 

Emetics, 136. 

Empyema, 381. 

Emulsion, 125, 237. 

Endocarditis, 347. 



Endometritis, 599. 
End organs, 705. 
Enema, 299. 
Enlarged kidney, 101. 

— Liver, 100. 
Entero-colitis, 464. 
Epidermis, the, 631. 
Epiglottis, the, 394. 
Epilepsy, 764. 

— From intemperate parents, 103. 
Eruption, 631. 

Erysipelas, 674. 
Erythema, 631. 

— Intertrigo, 653. 

— Multiforma, 654. 

— Simplex, 653. 
Ether, sulphuric, 145. 
Evacuations of the bowels, 458. 
Excessive sweat, 678. 
Excoriations, 631. 

Excreta, disposition of, 164. 

— How to disinfect, 121. 
Exercise, 30. 

— Active, 31, 

— Dangers from improper, 32. 

— For discharge of blood between men- 

strual periods, 585. 

— For failure of menstruation, 583. 

— Improper just before or just after 

meals, 36. 

— In infancy, 35, 439. 

— In pelvic diseases, 581. 

— Model modes of, 34, 40. 

— Of both sides of the brain, 45. 

— Outdoor, for women and girls, 38. 

— Passive, 32. 

— Physiological object of all, 35. 

— Regular hours for, 24. 

— Rest an important part of, 34. 

— Should call into action the whole 

body, 33. 
Expiration, 359. 
Extract, 125. 

Extraction of first teeth, 93. 
Extra-uterine pregnancy, 529. 
Exudate, 722. 
Eye, the, 400. 

— Contagious diseases of the, 402. 

— Diet in diseases of the, 409. 

— Shades, 408. 

— Slight ailments of the, 407. 

— Things not to be done to the, 409. 

— To remove foreign bodies from the, 

409. 

— Trouble, how to find the cause of, 

403- 

F. 

Facial paralysis, 737. 
Fainting, 793. 
Faith healing, 778. 
Falling of the womb, 607. 



INDEX. 



839 



Fallopian tubes, the, 500. 

Inflammation of the, 605. 

False economy in the use of fuel, 63. 

Falx, the, 707. 

Fatigue, a warning, 34. 

Fatness, 331. 

Fat of the beer drinker, 83. 

Fatty degeneration. 723. 

— Heart of alcoholism, 101. 
Fauces, the, 389. 

Feces, appearance of, in health and dis- 
ease. 458. 

— Impaction of the, 252. 
Feeble-mindedness, 798. 
Felon, 669. 

Female generative organs, 498. 

Feminine brain and nervous system, 573. 

Ferment, 236. 

Fermentation caused by bacteria, no. 

Fertilization of the ovum, 502. 

Fetus, diseases of the, 531. 

— Management of the, 533. 
Fever blisters, 643. 

— Brain, 758. 

— Child-bed, 546. 

— Diet in, 168. 

— Lung, 364. 

— Malarial. 270. 

— Nervous, 274. 

— Rheumatic. 316. 

— Spinal. 758. 

— Spotted, 758. 

— Typhoid, 258. 

At Hamburg, 71. 

How disseminated, 50. 

— Yellow, 292. 

Fibroid degeneration, 723. 
Filter galleries, 71. 
Filters, domestic, 72. 

— For rain water cisterns, 73. 

— Kinds of, that are unreliable, 69. 

— Sand. 67. 

Filth, a factor in disease. 54. 
Filtration. 67. 

— A bacteriological process, 68. 

— By percolation. 71. 

First aid to the injured, 217. 

Fissure. 631. 

Fits, 764. 

Flashes. 401. 

Flesh worms, 634. 

Flies spread disease, 51, 164, 259. 

Floors, hardwood and painted, 29. 

Flues and registers, 62. 

Fluid measure, 148. 

Fly paper poisoning, 179. 

Follicle. 681. 

Food, fried, not fit for the sick, 167. 

— Materials, the composition of, 85. 

— Quantity of, an adult should have, 

85. 
An infant should have, 435. 



Foods, administration of, 172. 

— ■ — To infants, 448. 

— Artificial, for infants, 442. 

— As a medium of infection, 49. 

— Classes of, 80, 82. 

— Digestibility of, 89. 

— Inorganic, 82. 

— Kinds of, to be avoided in fevers, 81. 

— The heat producing. 87. 

— The force producing, 80. 
Forced feeding, 589. 
Formaldehyde, 115. 
Formalin, 115. 

Foundation, the most important part, 

28. 
Fowler's solution, 127, 179. 
Foxglove poisoning, 190. 
Fractured bones, 224. 
Freckles, 676. 
Frost bites, 197. 

Fruit, preparation of. for food, 429. 
Functions of the body begin and end in 

what, 21. 
Funerals, when to be private, 166. 
Furniture, how to disinfect, 120. 

— Of the sick-room, 160. 
Furs, how to disinfect, 121, 
Furuncles, 670. 

G. 
Gall stones, 311. 
Ganglii, 710. 
Ganglion. 705. 
Gangrenous stomatitis, 453. 
Gas in the bowels, 268, 455. 
Gastralgia. 455. 
Gastric catarrh, 238. 

— Fever in infants, 455. 

— Juice, 236. 

Generation, the organs of, 495. 
Genital organs, diseases of the external, 

611, 
Germ causation of disease, 49, 210. 

Decay in teeth. 91. 

Suppuration, 218. 

Germ life destroyed by heat, 57. 

Influence of temperature upon, 51. 

German measles, 479. 

Germicides, all poisons, 112. 

Germs and interchangeable terms, 212. 

— Breeding places of, 51. 

— Number of, that render water unfit 

for use, 70. 

— Of diphtheria, kinds and growth of, 

279. 
Gid worm, the, 428. 
Gin drinker's liver, 100. 
Girls, diet for, 562. 

— To be informed of the higher social 

relations when, 565. 

Menstruation when, 565. 

Glasses, ground and smoked, 408. 

— Testing the eyes for, 411. 



840 



INDEX. 



Glaucoma, 401. 
Glioma, 754. 
Glycerine, 145. 
Goggles, 408. 
Gonorrhea, 696. 

— In the new born, 557. 
Gout, 326. 

Grade of grounds about the home, 28. 

Graffian follicles, the, 501. 

Grand mal, 764. 

Granulated eyelids, 402. 

Gravel, 336. 

Gray matter of the brain, 704, 709. 

Green sickness, 356. 

Grip, the, 275. 

Grutum, 634. 

Guiacol, 132. 

Gumma, gummatous ulcer, 692. 

Gymnasium, advantages of the, 34. 

H. 

Habit, the influence of, in nervous dis- 
eases, J2J. 

— The force of, 30. 
Hair, the, 681. 

— The color of the, 682. 

— The curl in, 682. 
Hallucinations, 801. 

Hamburg, cholera epidemic at, 71. 

— Water supply of, 70. 
Hands, care of the, 156. 
Headache, 785. 

Head lice, 655. 
Health lies in activity, 23. 
Healthy homes the cheapest, 25. 
Heart, anatomy^ and physiology of the, 
342. 

— Congenital defects of the, 345. 

— Degenerations of the, 351. 
— /Dilatation of the, 350. 

— Diseases of the, 342. 

— Diseases caused by alcohol, 101. 

— Hypertrophy or enlargement of the, 

350. 

— Palpitation of the, 351. 

— Rupture of the, 351. 

— Stimulants, 128. 

— Valvular diseases of the, 348. 
Heat as a disinfectant, 112. 

— And energy, amount of, required per 

day, 87. 

— Diseases, 55. 

— Stroke, 198. 
Hemiplegia, 754. 
Hemorrhage, cerebral, 752. 

— During pregnancy, 519. 

— From the bladder, 621. 
Nose, 316. 

— How to stop, 220. 

— In menstruation, 592. 

— Intracranial, 751. 

— Of the bowels, 264. 



Henbane poisoning, 185. 
Henle and Koch laws, 210. 
Heredity, 22. 

— In nervous affections, 725. 
Hernia, 229. 

Herpes simplex, 643. 

— Progenitalis, 643. 

— Zoster, 644. 
Hiccough, 360. 
Hives, 642. 
Hoarseness, 396. 

Hog manure, dangers from, 429. 
Hogs fed upon offal, 428. 
Holding infants, 439. 
Home, how made healthy, 122. 

— Location and construction of the, 26. 

— Must be an educator, 27. 

— Must never be built upon made 

soil, 26. 

— Selection of the, in the city, 27. 
Homes, healthy, 25. 

Hospital work in the Spanish war, 217. 

Hot water for the sick, 160. 

Human excreta, a source of danger, 65. 

Humidity, 54. 

Hydatid, 418". 

Hydragogues, 140. 

Hydrant water in homes, 65. 

Hydrocephalus, 755. 

Hydrochloric acid poisoning, 177. 

Hydrocyanic acid poisoning, 185. 

Hydrogen peroxide, 134. 

Hydropathy, 579. 

Hydrophobia. 204. 

Hygiene, the principles of, 22. 

Hymen, the, 496. 

Hyoscyamus poisoning, 185. 

Hyperemia, 631. 

Hyperidrosis, 678. 

Hypermetropia, 411. 

Hypertrophy of the brain, 721. 

Hypnotics, 141. 

Hypnotism, 776. 

Hysteria, 768. 

I. 

Icterus, 313. 

Ichthyol, 135. 

Idiocy, 798. 

Illusions, 801. 

Imbecility, 798. 

Immersion for burns, 199. 

Immune, how the system is made, 208. 

Improvement from judicious mating, 22. 

Incontinence, 618. 

Indigestion, 22,7. 

Infantile sore eyes, 406, 557. 

— Spinal paralysis, 742. 
Infection of the new born, 556. 
Infectious diseases, 49. 

Nursing in, 161. 

Inferior maxillary nerve, 729. 



INDEX. 



841 



Inflammation, 722. 

— Diet during, 168. 

— Of the bowels, 255. 

— Of the eyes, 402. 
Influenza, 275. 
Infusion, 125. 
Ingrowing nails, 668. 
Inhalation of hot air, 201. 
Injections, rectal, 141, 242. 
Innocent syphilis, 691. 
Inoculation, 284. 
Inorganic foods, 82. 

Insane, the, wards of the state, 820. 
Insanity, 795. 

— From alcoholism, 817. 
in parents, 103. 

— Menstruation in, 817. 

— Periodicity in, 816. 
Insomnia, 791. 
Inspiration, 359. 
Instruments for testing air, 63. 
Intestinal diseases in infancy, 462. 

— Obstruction, 251. 

— Parasites 418. 
Intestine, the large, 240. 
Intussusception, 251. 
Iodide of potassium 145. 
Iodine poisoning, 191. 

— Tincture of, 135. 
Iodoform, 135. 
Ipecac, 136. 

Iron, chloride of, 126. 
Itch, the, 65c . > 
Itching piles, p79. 

J. 

Jaundice, 31I. 

Jimson weed poisoning, 185. 
Joyous exercise, a factor of health, 34. 

K. 

Kalsomine better than wall paper, 29. 
Kidney, contracted, 337. 

— Diseases caused by alcoholism, 101. 

— Stone, 336. 

Klebs-Loffler bacillus, 278. 
Koch and Henle laws, 210. 



Labia minora et majora, 496. 
Labor, 534. 

— Antiseptic precautions before, 536. 

— Preparations for, 536. 

— The pains of, 535. 
Labyrinth, the, 413. 
Lachrymation, 405. 
La grippe, 275. 

In the new born, 557. 

Larynx, the, 393. 

— Diseases of the, 396. 

Latrines, the location and care of, 24. 



Laws for the procreation of life, 23. 

— Of life and health date back, 22. 
Laxatives, 139. 

Lead, 146. 

— Encephalitis, 763. 

— Forms of, 181. 

— Poisoning, 191, 762. 
Left-handed people, 44. 
Lentigo, 676. 
Lesion, 636. 

Leucorrhea of the pregnant, 406. 
Lichen planus, 641. 

Life and death, the antagonism be- 
tween, 23. 

— The physiological purpose of, 21. 
Ligaments, the broad and the round, 

499. 
Lightning, shocks from, 201. 
Lime, air-slacked is worthless, 117. 

— As a disinfectant, 114. 
Lithium, 145. 

Liver, the, 306. 

— Chronic congestion of the, 308. 

— Cirrhosis of the, 100. 

— Diseases caused by alcoholism, 100. 

— Patches, 677. 
Lobelia, 146. 
Locomotor ataxia, 647. 
London purple poisoning, 179. 
Lousiness, 654. 

Low temperature, diseases characteristic 

of, 56. 
Lozenge, the, 125. 
Lumbago, 323. 
Lungs, anatomy of the, 358. 

— Amenable to education, 36. 

— Developed by exercise, 2>^>- 

— Diseases of the, 358. 

— Influence of tobacco upon the, 105. 
Lying-in, the, should last how long, 545. 

M. 

Machinery, inanimate, 703. 

Mad dogs, 204. 

Mad stones, objections to the use of, 

206. 
Malaria, 270. 

— With typhoid, 266. 

— With yellow fever, 298. 
Male fern, 142. 

Malformations of development, 721. 
Malignant endocarditis, 347. 
Malignant pustule, 673. 

Malt preparations for nursing mothers, 

.436. 
Man differs from other animals how, 45. 
Man's neglect of his own race, 22. 
Mania, 807. 

Mania during pregnancy, 521. 
Massage, its advantages and defects, 32, 
586. 



842 



INDEX. 



Mastication, 236. 

Mastitis, 555. 

Mastoid process, 413. 

Masturbation, 698. 

Materia medica, 125. 

Maternal impressions, 432, 512. 

Mattresses, how to disinfect, 120. 

Measles, 477. 

— Black, 479. 

— German, 479. 
Measly pork, 418. 
Medicinal dose list, 150. 
Medulla, the, 501. 
Medullary sheath, the, 718. 
Meibomian glands, the, 633. 
Melancholia, 802. 
Meninges, the, 756. 
Meningitis, 722. 

— Alcoholic, 102. 

— Cerebro-spinal, 756, 758. 

— Suppurative, 757. 

— Tubercular, 760. 
Mental development, 566. 
Menthol, 134. 
Menopause, the, 624. 

— Inflammation of the uterus after the, 

626. 
Menstrual cycle, stages of the, 502. 
Menstruation, 567. 

— Care at first appearance of, 565. 

— Derangements of, 592. 

— Hemorrhage in, 592. 

— Painful, 570. 

— Premature, 567. 

— When girls should first be informed 

regarding, 565. 
Mercurial poisoning, 182. 

— Purgatives, 140. 
Mercury, forms of, 182. 
Metastasis, 482. 

Mice as carriers of disease, 51. 
Microbes destroyed by disinfection, in. 

— In the growth and decay of organic 

matter, no. 
Micrococci, 212. 
Micro-organisms, 49. 
Microscopic vegetable growths in water, 

68. 
Midriff, the, 358. 
Miliaria rubra, 645. 
Milium, 634. 
Milk as a beverage, 82. 

— As a medium of spreading disease, 

259- 

— A perfect food, 85. 

— Composition of, 81, 441. 

— Diet, advantages of, 81. 

— Lemonade, 170. 

— Of lime, 117. 

— Punch, 170. 

— Quality of the, 551. 

— To dry up the, 437. 

— To increase the, 436. 



Millers, average life of, 58. 
Mind healers, 778. 

— Power of the, over disease, 591. 
Mineral acid poisons, 177. 
Minor surgery, 217. 
Miscarriage, 525. 

Mixture, 125. 

Moles, 670. 

Monkshead poisoning, 184. 

Morphine habit, the, 108. 

— Objections to the use of, in colic, 

251. 

— When, is to be used, 108. 
Mosquitoes as carriers of malaria, 271. 
Mother, care of the, 539. 

— Diet of the, 540. 
Motor nerves, 706. 
Mountain sickness, 53. 

Mouth and throat, to disinfect the, 122. 

— Diseases of the, 452. 

— Washes, 93. 
Mucous patches, 690. 
Multiple neuritis, 735. 
Mumps, 481. 

Muriatic acid poisoning, 177. 
Muscular coats of the stomach, 235. 

— Development, a secondary matter, 

36. 
Mushroom poisoning, 192. 
Mustard, 136. 
Mutism, 754. 
Myalgia, 322. 
Myelitis, 741. 
Myopia, 411. 

N. 

Nasal ducts, the,' 405. 

Natural and sexual selection, 575. 

Nausea, how to overcome, 299. 

Navel cord, the, 555. 

Necrosis, 723. 

Nephritis, acute, 334. 

Nephrolithiasis, 336. 

Nerve centers, 713. 

— Force, nerve fluid, 31 

— Terminals, 706. 

— Trunks, 710. 
Nerves, cranial, the, 711. 

— Decussation of, 708. 

— How, are formed, 718. 

— Motor, 708. 

— Sensory, 709. 

— Spinal, 711. 

Nervous diseases of germ origin, 782. 

— Exhaustion, 594. 

— Symptoms, 784. 

— System, diseases of the, 703. 

Energized by good humor, 35. 

Nervousness in women overcome by 

outdoor life, 39. 
Nettle rash, 642. 
Neuralgia, 728. 
Neurism, 31. 



INDEX, 



843 



Neuritis, 733. 
Neuroses, the, 764. 
Nevus pigmentosis, 670. 
Necotianine, 104. 
Nicotine, 104. 

— Poisoning, 188. 

Night air, avoidance of, 24. 

— Terrors, 755. 
Nipples, sore, 549. 

Niter, sweet spirits of, 137. 
Nitric acid poisoning, 177. 
Nitrification, 71. 
Nitrogen, 52. 

— How, is made a part of plants, ill. 
Nitrogenous and non-nitrogenous foods, 

80. 
Nitroglycerine, 128. 
Nodules, 631. 

Noma, or gangrenous stomatitis, 453. 
Nose and throat, diseases of the, 381. 

— Bleed, 316. 
Nursing infants, 435. 

— The sick, 155. 

— The new born, 540. 
Nutrients, how, enter the blood. 237. 
Nux vomica poisoning, 189. 



O. 

Obesity, 331. 

Objects swallowed, 193. 

Oblongata, the, 707. 

— Diseases of the, 739. 
Observation of symptoms, 166. 
Obstetrics, 493. 

Offensive sweat, 679. 
Oiling the hair, 682. 
Onanism, 698. 
Onychia, 668. 
Onyxis, 668. 
Opthalmic nerve, 729. 
Opium, 146. 

— Habit. 108. 

— Poisoning. 186. 

Organs, freedom of, in every position, 

33- 

— Displacement of. by constriction, 39. 
Out buildings, 28. 

Ova. 501. 

Ovaries, the. 501. 

— - Congestion of the, 601. 

Ovaritis, chronic. 602. 

Oviducts, the, 500. 

Ox'bile, 147. 

Oxidation as a purifier, 72. 

Oxygen, 52. 



P. 



Pain in amputated limbs, 728. 
Paint, advantages of, 29. 
Palate, the, 389. 



Palpitation of the heart, 351. 
Palsy, Bell's, 73J. 

— The shaking, 779. 

— The wasting, 746. 
Pancreatic secretion, 236, 237. 
Pancreatin, 147. 

Papilla, 681. 
Papule, 631. 
Paralysis, acute ascending, 744. 

— Agitans, 779. 

— Bulbar, 750. 

. — General, 815. 

' — Infantile spinal, 742. 

— Pseudo hypertrophic muscular, 751. 
Paranoia. 810. 

Paraplegia, 754. 

Paresis, 815. 

Paretic dementia, 815. 

Paris green poisoning, 179. 

Parents should play with their children, 

36. 
Parotiditis, 481. 
Passion, the slave of, 22. 
Passions, danger from the uncontrolled, 

574- 

Pasteur treatment to prevent hydro- 
phobia. 207. 

Pathogenic germs. 49. 

Pathology of infantile disorders. 554. 

Pediculosis. 654. 

Pelvic anatomy, 493. 

— Deformity, 494. 

— Diseases, how lessened. 578. 

— Floor, 496. 

— Organs, acute inflammation of the, 

599- 

Chronic inflammation of the, 596. 

Pemphigus. 556. 

Pepsin. 147. 

Peptonizing tubes. 445. 

Pericarditis. 346. 

Perineum, rents in the, 545. 

Peripheral nerves, 706. 

Peritoneum, the. 255. 

Peritonitis. 255. 

Permanent dressing of wounds, 224. 

Permanganate of potash, 135. 

— Test of water, 75. 
Personal care of patients, 157. 
Pertussis. 483. 
Pharyngitis. 392. 

Pharynx, diseases of the, 389. 
Phenacetin, 131. 
Phenol poisoning, 190. 
Phimosis. 559. 
Phosphorous. 128. 

— Poisoning. 182. 
Photophobia. 405. 
Phrenic nerve, the, 712. 
Phthisis, 370. 

Physician's orders to be followed by the 
nurse, 156. 



844 



INDEX. 



Pia mater, the, 718. 

Pictures in the sickroom, 161. 

Piecing between meals, 242. 

Pigmentation' of the skin, 630. 

Piles, 679. 

Pimples, 631. 

Pin worms, 424. 

Plants in the sick room, 161. 

Plasmodium malaria, 270. 

Pleural cavity, the, 358. 

Pleurisy, 378. 

Plexus, 712. 

Pneumonia, 364. 

Poison apparatus of serpents, 203, 

— Hemlock, 186. 

— Ivy, 191. 

— Oak, 191. 

— Sumac, 192. 
Poisoning, 175. 

Poisons as medicines, 125. 

— Modern uses of, 176. 

— Quantity of, that will produce 

death, 177. 

Points to press to stop bleeding, 220. 

Polyuria, 328. 

Pomegranate, 142. 

Pons, the, 707. 

Porter as a beverage, 83. 

Post cervical ache, 804. 

Postures, correct in standing and sit- 
ting, 33- 

Potash salts as diuretics, 137. 

Pott's disease, 749. 

Power of the mind over the body, 163. 

Precautions against intestinal parasites, 
427. 

Precordial fear, 804. 

Pregnancy, care of the teeth during, 94. 

— Complications during, 518. 

— Condition of the uterus in, 516. 

— Diagnosis of, 509. 

— Disorders of the nervous system dur- 

ing, 520. 

— Duration of, 512. 

— Extra-uterine, 529. 

— Hygiene and management of, 513. 

— Infectious diseases during, 523. 

— Nausea and vomiting of, 521. 

— Nervous complications of, 549. 

— Signs of, 512. 
Premature birth, 559. 

— Delivery, 525. 
Preparation of foods, 167. 
Prepuce, elongation of the, 559. 
Presbyopia, 411. 

Prevention of consumption, 377. 

— Of the spread of germ diseases, 50. 
Prickly heat, 645. 

Primary dementia, 812. 
Privy vaults, 28. 

How to disinfect, 121. 

Procreative act, the, 22, 



Progressive muscular atrophy, 746. 
Prolapsus and procidentia, 232. 

— Of the uterus, 607. 
Proliferation, 722. 
Pronuclei, 502. 

Prostration from bruises, 228. 
Proteids, 80. 

— The digestion of, 444. 
Protoplasm, where created, 21. 
Prudence necessary in children of weak 

parents, 22. 
Pruritis, 613. 

— Ani, 679. 

Prussic acid poisoning, 185. 
Psoriasis, 639. 
Pterygium, 402. 
Ptomaine, poisoning, 192. 
Puberty, retarded, 569. 
Public baths, 77. 
Puerperal infection, 546. 
Pulse, the, 343. 

— To ascertain the, 166. 
Pumpkin seed, 142. 
Puncta, 405 = 
Purgatives, 139. 

Pus producing germs, 218. 

Pustule, 631. 

Putrefaction caused by germs, no. 



Quassia, 142; 

Quick Consumption, 378. 

Quinine, 127. 

— As an antiseptic, 130. 

— As a germicide, 130. 
Quinsy, 390. 

R. 

Rabies, 204. 

Rachitis, 490. 

Rag sorter's disease, 39. 

Rain baths, 77. 

— Water, 73. 

Rats, carriers of disease, 51. 

— Slaughter house, 427. 
Rectal prolapsus, 232. 
Rectum, the, 239. 
Recuperative power of man, 22. 
Red gum, 645. 

Reflex action, 715. 
Regeneration and repair, 720. 
Regularity in eating, 239. 
Relation of ovulation and menstruation, 
501. 

— Of the sexes, 576. 

Remedies recommended by friends, 156. 
Respiration artificial, 196. 

— Of the new born, 553. 
Rest, importance of, 34. 
Rete, the, 681. 

Retina, the, 401. 



INDEX. 



845 



Retroflexion, 607. 
Retroversion, 607. 
Rheumatism, acute, 317. 

— Chronic, 320. 

— Deforming, 324. 

— Favored by cold and damp, 54. 

— Muscular, 322. 
Rheumatoid arthritis, 324. 
Rhinitis, chronic, 383. 
Rickets, 490. 
Ringworm, 659. 

— Of the body, 663. 

— Of the crotch and axilla, 665. 

— Of the nails, 666. 
Roman baths, 76. 

Rooms, how to disinfect, 118. 

Rose, 674. 

Rotheln, 479. 

Round worms, 422. 

Rough on rats, poisoning by, 179. 

Rubber tubing, to stop hemorrhage by, 

221. 
Rugs, how to disinfect, 121. 
Run-around, 668. 

Running, posture of the body in, 33. 
Rupture, 229. 

S. 

Salicylate of sodium, 133. 

Salicylic acid. 133. 

Saline purgatives, 139. 

Saliva, 236. 

Salivation, 237. 

Salol, 133. 

Salt rheum, 648. 

— What it does for us, 82. 

Sand, action of, in germ destruction, 70. 

— Filters, 67. 

— Size of, required for filters, 70. 
Sandow, the athlete, 45. 

Sanitary science, embraces what, 23. 

The chief problem of, 63. 

Santonin. 142. 

Sarcini. 212. 

Sarcoma, 754. 

Scabies. 656. 

Scald-head, 660. 

Scalds. 199. 

Scarlet fever. 473. 

Scarletina. 476. 

Scars prevented by skin grafts, 201. 

Schoolrooms, the light of, 410. 

— The ventilation of, 61. 
Sciatica. 731. 
Sclerosis, arterio. 354. 

— Of the nerves. 723. 

— Spinal. 750. 

Screens in the sick-room. 160, 161. 

— May prevent disease, 56. 
Scrofula. 488. 
Sea-sickness. 252. 

Seasons, diseases peculiar to certain, 56. 



Seat worms, 424. 

Sebaceous glands, diseases of the, 633. 

Seborrhea, 635. 

Secretory nerves, 706. 

Sedimentation, 66. 

Segmentation, 271. 

Segmentation-nucleus, the, 502. 

Self-abuse, self-pollution, 698. 

Seminal losses, 700. 

Senile dementia, 812. 

Senility, the nerves in, 724. 

Sensory nerves, 706. 

Serum treatment of consumption, 376. 

— Of the blood. 344. 

Settling basins for purifying water, 66. 
Sewer connections, dangers from, 58. 

— Gas, 58. 

Sewage manure, dangers from, 429. 
Sexes, relation of the, 576. 
Sexual development of girls. 564. 

— Functions, derangements of the, 594, 

— Instinct, 574. 

— Organs, malformation of. 569. 
Partial development of, 569. 

— Selection. 575. 
Shafts.- ventilating. 60. 
Sheath, the medullary, 718. 

— Of Schwann. 718. 
Shingles, the. 644. 

Shoes, importance of well fitting, 40. 

Sick-headache, 768. 

Sickness, care of the teeth during. 94. 

Sick-room, arrangement of the, 159. 

Sighing, 360. 

Signs of pregnancy, relative value of 

the. 512. 
Silver nitrate. 147. 

Singing, control of the breath in, 395. 
Sitting, correct posture in, 33. 
Size of an infant determined by what, 

505- 
Skin diseases, 629. 
Terms used in considering, 631. 

— Grafting to prevent scars, 201. 

— Inflammation of the. 651. 
Skins, how to disinfect, 121. 
Slaughter house refuse, dangers from, 

427. 
Sleeplessness, 791. 
Sleep of infants, 437. 

— One-third of the time to be given to, 

24. 
Small-pox, 283. 
Snake bites, 202. 
How stimulants should be given 

for. 84. 
Sneezing. 360. 
Snuff, effects of. 107. 
Soap as a disinfectant, 114. 
Social condition, influence of. in nervous 

diseases. 727. 
Soda as a disinfectant, 114. 



846 



INDEX. 



Soil on which to build, 25. 

Solution, 125. 

Solutol as a disinfectant, 113. 

Somnambulism, 772. 

Sore throat, 391, 392. 

Sowing wild oats, 577. 

Spanish windlass to stop bleeding, 221. 

Speaking, control of the voice in, 395. 

Special poisons, 177. 

Spermatorrhea, 699. 

Spinal canal, 705. 

— Centers, 715. 

— Cord, diseases of the, 739 
Injuries of the, 749. 

— Hemorrhage, 745. 

— Nerves, 706, 711. 

— Sclerosis, 750. 
Spirilla, 212. 

Spitting, a source of danger, 50. 
Splints, 224. 
Spores, 213. 
Spotted fever, 722. 

— Hemlock, poisoning, 186. 
Sprains, 225. 

Sputa, how to disinfect, 122. 
Squill as a diuretic, 138. 

— As an emetic, 136. 
Squamae, 631. 

Stages of the embryo and fetus, 502. 

— Of the menstrual cycle, 501. 
Stains upon the skin, 631. 
Stand erect, how to, S3- 

St. Anthony's dance, 767. 

— Fire, 674. 
Staphylococci, 212. 
Staphylococcus albus, the producer of 

white pus, 218. 

— Aureus, the producer of yellow pus, 

218. 
Starch, the digestion of, 237. 
Starches and sugars, 80. 
Starchy foods, how to cook, 167. 
Steam as a disinfectant, 118. 

— Baths, 79. 
Steatoma, 633. 
Sties, 401, 633. 
Stimulants and narcotics, 96. 
Stings of insects, 202. 
Stomach, the, 235. 

— And bowel diseases, diet in, 170. 
• — Children's diseases of the, 4555. 

— Disorders caused by alcoholism, 99. 

— Tube, how made and used, 239. 
Stomatitis, catarrhal, 452. 
Stoves, poisonous gases from, 57. 
Stoves, ventilation of houses warmed 

by, 61, 63. 
Stramonium poisoning, 185. 
Strangulated hernia, 231. 
Strangulation, 251. 
Strength and endurance caused by 

what, 31, 



Streptococci, 212. 

Stretcher, an improvised, 224. 

Striae gravidarum, 507. 

Strictures, 697. 

Strychnia poisoning, 189. 

St. Vitus' dance, 767. 

Subinvolution, 547. 

Sudden changes tend to disease, 56. 

Suffocation, 197. 

Sugar in urine, 328. 

Sulphate of copper, 136. 

Sulphonal, 141. 

Sulphur as a disinfectant, 114. 

Sulphuric acid poisoning, 177. 

Summer complaint, 464. 

Sunlight as a disinfectant, 112. 

— As a purifier of water, 72. 

— In every room, 25. 
Sunstroke, 198. 

— Causes of, 55. 

Superior maxillary nerve, 729. 

Suppurative otitis media, 414. 

Surface water, danger from, 67. 

Surgical cleanliness, 219. 

Sweat glands, disorders of the, 678. 

Swedish movements, 586. 

Swimming, 79. 

Sympathetic nervous system, 715. 

Symptoms, the observation of, 166. 

Syphilis, 687. 

— In the new born, 557. 
Systole, 344. 

T. 

Tabes dorsalis, 747. 

Table of alcoholic strength of liquors, 
129. 

Composition of food materials, 

85, 86. 

Fuel values of food per pound, 87. 

Quantity of nutrients one dollar 

will buy, 87. 

Time required to digest various 

foods, 90. 
Tablet, the, 125. 
Tape worms, 418. 
Tartar emetic, 137. 
Tea as a beverage, 83. 
Teeth, the, 91. 

— At birth, 449. 

— Care of, in infancy, 450. 

— Care of the permanent, 94. 

— Care of the temporary, 92. 
.Temperature, its influence upon health, 

54- 

— Of infants, 440. 

— Of the sick room, 160. 

— How to reduce the, 130, 286. 
Temporary dressing of wounds, 220. 
Tenotomy, 744. 

Terminal dementia, 812, 
Tetanus, 782, 



INDEX. 



847 



Tetrads, 212. 

Tetter. 648. 

Thoracic breathing, 38. 

Thorn apple poisoning, 185. 

Thread worms, 424. 

Thrombosis, 751. 

Thrush, 4 54- 558. 

Tic douloureux, 731. 

Tincture, 125. 

Tinea trycophytina, 659. 

Tissue building foods, 80. 

In children. 35. 

Tobacco. 104. 

— Habit, treatment for the, 107. 

— Indian. 146. 

— Poisoning, 105. 
Tonics. 126. 
Tonsilitis. 390. 

— Follicular. 391. 
Tonsils, the. 389. 
Toothache, the control of, 95. 
Tooth powders, 93. 

Tourniquet, use of the, to stop bleed- 
ing. 221. 
Trachea. 358. 
Training children, should begin when, 

434- 
Trance. 773. 
Traumatic affections of the spinal cord, 

748. 
Trees about the home, 25. 
Trichinosis, 425. 
Tricresol, 113. 
Trional, 141. 
Troches, 125. 
Trophic nerves, 706. 
Truss, how to cure hernia by a, 232. 

— How to secure a perfect fitting. 229. 
Tubercle. 631. 

Tuberculosis of the lungs. 370. 
Tumor. 631. 

— Of the brain. 754. 

Tumors and adventitious products, 724. 
Turbinate bodies, 384. 
Turpentine, the oil of, 138. 

— Poisoning. 193. 

Toxine treatment of disease, 211. 
Toxines of dead cells, 23. 
Twitching eyelids. 401. 
Type for testing sight, 412. 
Typhlitis, 253. 

U. 

Ulceration. 631. 

Ulcer of the eye, 402, 406. 

— Of the stomach, 240. 
Ulcerative stomatitis, 453. 
Umbilical cord, the. 506. 
Upholstery, how to disinfect, 120. 
Urethra, the, 497. 

Urinary organs, diseases of the, 617. 



Urine, abnormal, 622. 

— Incontinence of, 548. 
Urticaria, 642. 

Uterine contractions, 544. 

— Fibroids or tumors, 615. 
Uterus, cancer of the, 616. 

— Complete prolapsus of the, 627. 

— Diameter of the, 606. 

— Displacement of the. 606. 

— Falling of the, 607. 
In the aged, 626. 

— Inflammation of the. after the meno- 

pause. 626. 

— Rents in the mouth of. 545. 

— Return of the. to normal size, 548. 

— The, and its connections, 497. 

— Tumors of the, 615. 
Uvula, the, 389. 



Vaccination. 291. 
Vaccinia. 290. 
Vagina, the, 497. 

— Inflammation of the, 615. 
Vaginitis, 615. 

Valves of the heart, 343. 

Valvular diseases of the heart, 348. 

Vapor baths. 79. 

Varicella, 480. 

Varicose veins, 354. 

Vascular disturbances of the brain, 724. 

Variola, 283. 

Vaso-motor nerves, 706. 

Vegetable diet, 81. 

— Growths in sand filters, 6S. 

— Remedies, 176. 

— Spores in water, 68. 

Vegetables, preparation of, for food, 429. 
Veins, enlarged. 354. 

Pelvic, 627. 

Vena cava, the, 343. 
Venereal diseases, 687. 
Ventilation, 59. 

— In infectious diseases, 162. 

— Of a girl's room, 563. 

— Of cellars, 28. 

— Of the sick-room, 159. 
Ventilating with cold air, 61. 

— Flues and registers, proper size of, 

62. 
Ventricles, the, 343. 
Verdigris poisoning, 188. 
Vermiform appendix, the, 253. 
Vernix caseosa, 432. 
Verruca, 646. 
Vertigo. 784. 
Vesicles. 631. 

— The air, 359. 
Villi, the. 344. 
Vocal cords, the, 394. 



848 



INDEX. 



Voice, the, 393. 

— Precautions in the care of the, 398. 
Voight's tables, 85. 

Vomit, black, of yellow fever, 295. 
Vomiting caused by alcohol, 99. 

— In infancy, 456. 

— How to prevent, 289, 299. 

Vulva, hyperesthesia or irritableness of 
the, 614. 

— Itching of the, 613. 
Vulvitis, 612. 

W. 

Walking, posture of the body in, 33. 
Wall papers, things preferable to, 29. 
Walls, double to prevent dampness, 28, 
Warts, 646. 
Wasp waists, 38. 
Water, 65. 

— As an antipyretic, 130 

— As a beverage, 82. 

— Borne diseases, 49. 
Care of, 164. 

— Closets, how to disinfect, 122. 
■ — As a diuretic, 137. 

— Dangers from impure, 65. 

— On the brain, 755. 

— Purification of, by cold, 72. 

Filtration, 67. 

Heat, 72. 

Nitrification, 71. 

— Rain, 73. 

— Sources of supply of, 67. 

— Supply of Hamburg and Altona, 70. 
— The home, 25. 

— To reduce the temperature of the 

body by, 130, 268. 

— Use of, in treating disease, 579. 

— Warm, as an emetic, 136. 
Watery eyes, 405. 
Weaning the child, 552. 
Weights and measures, 148. 
Weight of the new born, 553. 
Wells, dangers from, in cities, 65. 

— Distance they must be from the 

privy, 66. 

— Which should be condemned, 66. 



Wens, 634. 

Wetting the bed, 618. 

Wheals, 631. 

Wheat, the composition of, 81. 

Whey as food for infants, 444. 

White matter of the brain, 704. 

Whitewash, 29. 

Whisky as a beverage, 84. 

Whitlow, 669. 

Whooping cough, 483. 

Will force, 31. 

— Importance of, in muscle build- 

ing, 46. 
Winds as carriers of disease, 56. 

— Hot and dry, injurious to health, 56. 
Wine as a beverage, 84. 
Wolfsbane poisoning, 184. 
Woman's health in mountain districts, 

40. 

— Endurance and recuperative powers, 

574- 

— Nervousness overcome by outdoor 

life, 39. 
Women, care of, in pregnancy, 493. 

— Diet for young, 562. 

— Diseases of, 561. 

— Should breathe abdominally, 38. 

— Whose floating ribs overlap the 

stomach, 39. 
Wool and rag sorters' disease, 59. 
Worms, 418. 
Wounds, the permanent dressing of, 

223. 

— The temporary dressing of, 220. 
Wrist-drop, 763. 



Y. 

Yellow fever, 293. 
Young women, diet for, 



Z. 

Zinc poisoning, 191. 
— Sulphate, 136. 

As an emetic, 137 

Zoster, herpes, 644. 



562. 



